Wiki filing breast expander

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roxaneas

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Does anyone know how to bill for filling breast expanders. We billed to medicare and they denied stating the claim needed a different modifier or the one used was not correct. We did the E/M code with a 11951 modifier 25. This office did not do the original surgery and it is withing the 90 global days. We are doing the filling of the expanders to assist the patient because of the travel distance to see the surgeon. thanks.
 
Read your CPT book

Read the descriptions of the procedures in your CPT book.

First - 11951 is for subq injection of filling material (e.g. collagen) ... that is into the patient's own tissues, not into a tissue expander.

Second - modifier -25 can go ONLY on the E/M code

Third - Insertion of any tissue expander INCLUDES subsequent expansion. If your doctor is taking over the postoperative care (expansion) from the original surgeon then you should be coding the same basic procedure that the surgeon used. You will use a -55 modifier (the surgeon who placed the expander needs to use a -54 modifier).

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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