General Surgery Coding Alert

Revisions to the Physician fee schedule Database will have an immediate effect on how you report two breast excision procedures, one localization procedure and a venography injection code. Read on to get the scoop.

Turn to 50, Not LT/RT for Breast Procedures

You'll no longer have to turn to modifiers LT (Left side) and RT (Right side) when reporting breast biopsy procedures 19120 (Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion [except 19140, mastectomy for gynecomastia], open, male or female, one or more lesions) and 19125 (Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion) or needle localization wire placement (19290, Preoperative placement of needle localization wire, breast). CMS transmittal 558, released May 6, contains updates to the 2005 Physician fee schedule Database that change these procedures' bilateral surgery indicators from "0" to "1."

What it means: Previously, you could not use modifier 50 (Bilateral procedure) to indicate when the surgeon performed 19120, 19125 or 19290 bilaterally (that is, on both the left and right breasts). The only way to indicate that the surgeon had performed these services bilaterally was to report the code twice and append modifier LT to one of the codes and modifier RT to the other.

Now, however, because of the fee schedule updates, you can use modifier 50 to indicate a bilateral procedure.

Example: The surgeon excises a benign mass on the patient's left breast. During the same surgical session, the surgeon removes some aberrant tissue from the right breast.

Old way: Prior to the revisions, you would have coded this 19120-LT, 19120-RT.

New way: Per the new guidelines set forth by transmittal 558, you would now report the procedure  using 12190-50.

Note: You may still apply either modifier LT or RT for unilateral claims to indicate the precise breast the surgeon treated, if you desire.

Expect Better Pay for Bilateral 36005

You'll want to keep an eye on any claims for 36005 (Injection procedure for extremity venography [including introduction of needle or intracatheter]). Transmittal 558 includes revisions that change this injection procedure's bilateral indicator from a "0" to a "1."

Good news: The change means that surgeons who perform 36005 can expect additional compensation for bilateral claims with modifier 50 appended. In the past, Medicare would not pay an increased fee for such bilateral injections. Based on the Fee Schedule update, however, surgeons can now expect 150 percent of the unilateral fee for bilateral injections reported using 36005-50.

CMS transmittal 558 outlines updated Fee Schedule information for several dozen CPT codes, including several Category III (temporary) codes. Of the changes, those to 19120, 19125, 19290 and 36005 are most relevant to general surgery practices.

Learn More: To view the complete text of CMS transmittal 558, visit the CMS Web site at www.cms.hhs.gov/manuals/pm_trans/R558CP.pdf.