Wiki Immediate Insertion of breast prosthesis.

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ssharris

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We are having problems with PA Medicare. Our general surgeon performs the mastectomy and then the Plastic Surgeon is performing the immediate insertion of breast prosthesis in the same session.

Medicare is stating that they will not pay the plastic surgeon for 19340 because it is an add on code and the primary code is not billed by him.

I can not find anything to state that this does not have to be billed separatley other then the obvious.

Any ideas out there.

Thanks
Sue
Guthrie Clinic
 
appeal it

First off, 19340 is NOT an add on code. Gather the records from both physicians, and copy the page in the CPT book and appeal it.

One of my plastics does many surgeries with general surgeons and we've never encountered this problem.
 
I am in Ohio and we just started having this problem in the last few months. I was told the exact same thing. So I had to file some appeals and I am still waiting for an answer. Now we are deciding what to do, basically the only option is for the doctors to do the mastectomy and reconstruction, because if they don't do both, they are taking a chance on doing the reconstruction for FREE!!! Wish I had better news for you.

Terri
 
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