General Surgery Coding Alert

Answer: If the mastectomy is radical, 19200 would be the primary code; if it is modified radical, 19240 should be used. The excision of the left breast mass probably would be 19120 (excision of breast lesion) but also could be 19160 (mastectomy, partial) if a significant amount of breast tissue was excised (usually more than a quadrant), says Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill. All of the codes listed must be supported by the operative report.

According to the Correct Coding Initiative, used by the Health Care Financing Administration (HCFA), 19120 or 19160 is bundled into either 19200 or 19240 and would need appropriate modifiers to indicate a separate site. Code 19200 or 19240 would take an -RT (right side) modifier, and 19120 or 19160 would take an -LT (left side) modifier. Depending on your Medicare carrier, modifier -59 (distinct procedural service) also might be needed with 19120 or 19160 in addition to the -LT modifier in order to clarify the site.

If the carrier does not recognize -RT and -LT, modifier -59 might be the only modifier needed on the 19120 or 19160 code, Mueller says, adding that some carriers do not recognize any modifier, and this claim may need to be adjudicated with the operative report.