General Surgery .vs Plastic Surgery

Osceola, IN
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I work for a plastic surgeon who performs breast reconstruction on cancer patients who are having a mastectomy. She works in conjunction with the general surgeon who is performing the mastectomy, he will be one side doing the mastectomy while she is doing reconstruction on the other side, they are literally in the same operating room at the same time. He of course bills out separately as he is not part of our practice and is not the same specialty. I only bill out for my doctor who is the plastic surgeon. We have an outside billing company who reviews all of the codes I submit for our encounters, and they always kick back the codes for these cases. The argument they present is that the general surgeon will bill out the mastectomy codes and my surgeon’s codes will get bundled with his. An example is she is billing out 19318-50, she began on the right breast for symmetry while the general surgeon performed a mastectomy on the left breast. Once he was done, she began her portion on the left breast.

Are the codes going to get bundled when we are billing from two different specialties, two different practices?

Thank you in advance for any help with my question.


Peru, IN
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They are right you can't bill 19303 with 19318 on same breast. You can bill 19318-RT though.
What exactly is your doc doing on the mastectomy breast?