• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Breast Reconstruction and Modifier 59

J

jhartung

Guest
Messages
26
Location
Hudson Falls, NY
My doctor is charging the following codes for a breast reconstruction for one of our patient:

15734 - Muscle Myo/Fasciocutaneous flap-trunk
19371 - capsulectomy, periprosthetic breast
19328-59 - removal of intact mammary implant
19357-59 - breast recon. w/tissue expander, including subsequent expansion

The insurance company (MVP) paid for 15734 and 19371, but said that 19328 and 19357 are integral to 19371. I can understand how they could say that the removal of the implant would be considered part of the capsulectomy procedure, but I cannot find any CCI edits or any other documentation which states that 19357 is inclusive to ANY of these procedures. Am I missing something?:confused:
 
Code 19328 and code 19357 are MUTUALLY EXCLUSIVE. A modifier is allowed to override t

Code 19328 and code 19357 are MUTUALLY EXCLUSIVE. A modifier is allowed to override this relationship.


Modifier 59 is placed on both codes? Shouldn't it only be on the column 2 code 19327-59. You are right you would need a modifier to support seperate session, seperate site, bilateral. If he is doing in the same anatomical site than they would be inclusive and only pay the 19328.
 
You must log in or register to reply here.
Top