coderD814
Networker
Please help!! For 2024, can 11970 & 19370 both be reported for same breast. I read all the guidelines & articles but honest, the way some of them are worded I get confused. 
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Wiki 11970 & 19370 on same breast
- Thread starter coderD814
- Start date
xXxPARAGONxXx
Guest
Yes, per CMS NCCI Edit File, add modifier -59 to 11970 and the appropriate laterality modifier to both.Please help!! For 2024, can 11970 & 19370 both be reported for same breast. I read all the guidelines & articles but honest, the way some of them are worded I get confused.
I personally do not have experience with breast surgeries, and didn't see the documentation. While it is possible to bill both 19370 with 11970-59, I would want to ensure that -59 is appropriate in this situation. Additionally, some carriers prefer -XU, -XS, or -XE which are more specific than -59.
There is a reason the NCCI edit is there in the first place, and universally adding -59 to override is not always appropriate.
There is a reason the NCCI edit is there in the first place, and universally adding -59 to override is not always appropriate.