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coding help - breast augmentation

samyjm13

Guru
Messages
175
Location
Meridian, ID
Best answers
0
Patient had a breast augmentation and her plastic surgeon does a fluid expansion every 2 weeks, this is done under the global and is not charged out each time. However, she is coming to our clinic and having this fluid expansion done and she is not under her global here at our office. This is a new one on me for the fluid refill and am not sure how to code the CPT other than unlisted procedure, breast 19499, and the ICD 9 code had me a little concerned as well. Would this still be considered reconstruction? PLEASE HELP!

Thank you
 

LindaEV

Expert
Local Chapter Officer
Messages
438
Location
Kansas City, MO
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0
What is the code the plastic surgeon uses for the initial procedure that the fills fall under? Are you doing all the "post op" care? Can you bill that code with a 55 modifier?

Why are you guys doing it and not him? are you covering for him? maybe a financial agreement should be made with him?

I wish I could give you better answers....maybe you could give a little more info.
I am guessing this is not cosmetic??
 

samyjm13

Guru
Messages
175
Location
Meridian, ID
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0
The original code was 19357, and yes I am thinking a mod. 55 is needed. The patient has this done every 2 wks. and her plastic surgeon is 200 miles away and she is having our GS doing the infusions. Our physician has done one (that's the one I am trying to code), but she is coming back in 2 wks for another one. So...would I use another mod. 55 on the second code. Also, is the 19357 the only code I would be using? This is a new one on me.

Thanks
Jeanne, cpc
 
Messages
4,466
Location
Milwaukee WI
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0
Did both doctors know this in advance?

Did both the plastic surgeon and your physician know about this in advance?

If yes, then the plastic surgeon should have used a -54 modifier on the procedure to indicate that postoperative care would be handled by another physician.

YOU would then code the exact same procedure as the plastic surgeon (i.e. the insertion of the expander), with a -55 modfier. You would code this only once because it tells the payer that you are taking over the post-operative management of this case.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

samyjm13

Guru
Messages
175
Location
Meridian, ID
Best answers
0
I have a concern on this because the our GP is only doing the saline infusion in the expander through an infusion port. There is going to be a cost difference from the infusion than the reconstruction. Since there is not a CPT code for this wouldn't I use 19499 with a modifier 55.

Jeanne
 

samyjm13

Guru
Messages
175
Location
Meridian, ID
Best answers
0
And since there is not a specific code for this could a person report an E&M code for the service just for the infusion of the saline solutuion through the port in the breast.
 
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