Wiki excision gynecomastia

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szoldey

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I used diagnosis 611.1 for the gynecomastia and procedure 19300 for the excision of the gynecomastia. I am getting grief for this because they are stating that the whole breast had to be removed for this code. I beg to differ.... Any input would be greatly appreciated.
 
Thank you. Is there any info out there that would explain that the tissue is removed and not the whole breast? I was informed that my code was going to be changed to 19120. I disagree with this because of the path report stating the gynecomastia. Thanks again.:)
 
Can anyone tell me if the liposuction is billable separately? My Plastic doc wants to bill separately for the lipo with the 19300 and I thought this was included. I can use as much advice as possible - and any concrete documentation to back it. This doc will only believe what she sees in writing - and really only wants to see it by the ASPS!
 
It's been a few years since I worked in Plastic Surgery but they do have a paper that I used to use:
http://www.plasticsurgery.org/Docum...insurance/Gynecomastia-Insurance-Coverage.pdf

It's a bit old but the information was quite useful. You need to make sure you code correctly for the gender of the patient, and you could also do a search online in relation to the specific insurance carrier. Many have published medical policies for this procedure because there are certain criteria to meet.

In regard to the liposuction, if it was performed, I did code for liposuction of the trunk in addition to the mastectomy for gynecomastia but I don't remember how or if it was paid.

hreed
 
Thanks HReed. That was helpful, but a little old as the codes have changed since that paper was written. I have checked the medical policy though for this patient's insurance and it states to bill for the liposuction separately, so I will send this out that way and see what happens!

Thanks again!
 
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