Wiki Help, please coding breast reduction and excess axillary tissue

[dchagy]

Surgeon does breast reduction and excises excess tissue in the axillary regions. Sometimes calls them bra rolls. Is the excision included in breast reduction 19318? Non cancerous reduction. Since axilla and breast is in a different anatomical location can the bilateral axilla removal also be billed or charged as a cosmetic fee? Cpt 15839 is the only code I am aware of but is considered cosmetic with breast reduction. The only diagnosis I can come up with is adipose tissue. I know the excess tissue in the axilla area is not always medically necessary sometimes, all women have them. The doc wants the patient to be pleased with his work and look good. Is this separately billable? God knows if it is included with 19318 I want to forget about it. This has been an ongoing question I cannot get answered. Need your opinions and expertise.

 

[surgonc87]

Redundant axillary tissue with early stage maceratation/rash excision may be consider a cosmetic procedure. There has to be an extensive rash/infection/painful to be deemed medically necessary. A letter has to be sent out with documented chronic problems in regards to that for the insurance company to even consider the excision of redundant skin.

So in the patient consult, maybe can bring that up as an additional cost as it is not medically necessary to remove and will not be covered by insurance companies.

hope that helps a little
mS