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Breast Reduction for symmetry - Medicare Part B Alabama

A

acgibson@namccares.com

Contributor
Messages
14
Location
Florence, AL
CPT Code 19318
Medicare in Alabama's LCD only has one primary diagnosis (Macromastia) for breast reduction post mastectomy for symmetry. Not EVERY patient has that as a primary diagnosis. Other carriers have "Cancer" diagnoses as covered when listed as primary. I have contacted our Carrier and they "insinuate" that the 19318 code is incorrect, of course they will not tell me why. Anyone else with the same issue?
 
acgibson@namccares.com said:
CPT Code 19318
Medicare in Alabama's LCD only has one primary diagnosis (Macromastia) for breast reduction post mastectomy for symmetry. Not EVERY patient has that as a primary diagnosis. Other carriers have "Cancer" diagnoses as covered when listed as primary. I have contacted our Carrier and they "insinuate" that the 19318 code is incorrect, of course they will not tell me why. Anyone else with the same issue?
Click to expand...
We are having the same issue in Michigan. I tried billing 19316 just waiting on determination.
 
What if you billed it with the diagnosis code N62 then if it is breast cancer use the secondary diagnosis of Z85.3, because the reason you are doing the contralateral breast is because it doesn't match and it is too big with the reconstructed breast.
 
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