General Surgery Coding Alert

Question: Our surgeon performed a mastectomy on a male patient with a suspicious breast mass. The final diagnosis was gynecomastia. Must we bill the procedure as 19300, or can we bill 19303 since the surgeon didn't know the diagnosis before the surgery?

Missouri Subscriber

Answer: Without further documentation, you would need to code this case as 19300 (Mastectomy for gynecomastia) instead of 19303 (Mastectomy, simple, complete).

If the surgeon provides some documentation regarding why he thought the breast mass needed to be removed, such as an abnormal fine needle aspiration or biopsy, you could code the procedure as 19303.

But you don't mention any intraoperative or prior diagnoses. A surgeon would not typically perform a mastectomy without first getting biopsy results, so this would be an unusual scenario.

Without further documentation, it appears that the surgeon performed the mastectomy for gynecomastia (611.1, Hypertrophy of breast), even if he didn't know the final diagnosis for sure prior to surgery. Payers rarely cover 19300, because they consider it a cosmetic procedure.