15771 and 15772 to breasts and how to bill

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Boulder, CO
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I'm confused about how to bill these two codes when it's a bilateral procedure. CPT Coding Essentials for Plastics and Derm states that 15771 is for 50cc or less and can only be reported once per session. 15772 is to be listed separately in addition to code 15771.
For example If the doctor injects 70 cc into each breast, how would this be coded? 15771 with a 50 modifier and 15772 with a 50 mod? Does the once per session mean once for that surgery? So I would never code 15771 with a right modifier and 15771 with a left modifier?
 

haraml7

Networker
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HI,
15771 does have guidelines showing "15771 should be billed once per session", BUT when looking at this code there is a "0" payment indicator per the fee schedule which states that bilateral (50 modifier) would not be payable for the code 15771.
When reading the guidelines before the code, it states "for multiple sites of injection, sum the total volume of injectate to anatomic sites that are grouped together into the same code descriptor." So what this is saying that you would take you total CCs for both breasts and code the full amount of CCs for both breasts, since the breast are in the same anatomical area.
Also, you never want to put a modifier on an add-on code, it will always deny.

So, per your example, I would bill 140ccs, by adding 70cc per breast, and code 15771 (50ccs), 15772 x 2 units (100 ccs) which equals the 140ccs for both breasts.
(the MUEs for 15772 is 9, so there is plenty of units to go around for the 15772.)

I hope this helps. Please don't hesitate to reach out if you have anymore questions.
 
Messages
9
Location
Boulder, CO
Best answers
0
HI,
15771 does have guidelines showing "15771 should be billed once per session", BUT when looking at this code there is a "0" payment indicator per the fee schedule which states that bilateral (50 modifier) would not be payable for the code 15771.
When reading the guidelines before the code, it states "for multiple sites of injection, sum the total volume of injectate to anatomic sites that are grouped together into the same code descriptor." So what this is saying that you would take you total CCs for both breasts and code the full amount of CCs for both breasts, since the breast are in the same anatomical area.
Also, you never want to put a modifier on an add-on code, it will always deny.

So, per your example, I would bill 140ccs, by adding 70cc per breast, and code 15771 (50ccs), 15772 x 2 units (100 ccs) which equals the 140ccs for both breasts.
(the MUEs for 15772 is 9, so there is plenty of units to go around for the 15772.)

I hope this helps. Please don't hesitate to reach out if you have anymore questions.
Thank you so very much! I saw this after you posted but had trouble replying. This was very helpful.
 
Messages
9
Location
Boulder, CO
Best answers
0
HI,
15771 does have guidelines showing "15771 should be billed once per session", BUT when looking at this code there is a "0" payment indicator per the fee schedule which states that bilateral (50 modifier) would not be payable for the code 15771.
When reading the guidelines before the code, it states "for multiple sites of injection, sum the total volume of injectate to anatomic sites that are grouped together into the same code descriptor." So what this is saying that you would take you total CCs for both breasts and code the full amount of CCs for both breasts, since the breast are in the same anatomical area.
Also, you never want to put a modifier on an add-on code, it will always deny.

So, per your example, I would bill 140ccs, by adding 70cc per breast, and code 15771 (50ccs), 15772 x 2 units (100 ccs) which equals the 140ccs for both breasts.
(the MUEs for 15772 is 9, so there is plenty of units to go around for the 15772.)

I hope this helps. Please don't hesitate to reach out if you have anymore questions.
Thank you so very much! I saw this after you posted but had trouble replying. This was very helpful.
 
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