• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We’re introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

no breast mass - modifer 74

codedog

True Blue
Messages
956
Location
NEW ORLEANS
Best answers
0
Patient had MAC anesthesia, was bought to operating room , was examined , could not find a papable mass , so a decision was to abort the procedure. . Operative report stated breast exam. Surgery was booked at our ASC as -Excision of breast mass -cpt code 19120
.. ,
in operative note it stated patient will be scheduled next
for radiologic imaging and next incision will be a radiologic need localization -which IS CPT CODE 19125-
Now here is my question ?
DO i code 19120 rt with modifer 74 now with dx code v64.3 and what was also 611.72 that was on the booking
or breast exam which I dont think is right, any suggestions please bring them on .THANKS
 
Last edited:

nsteinhauser

Expert
Messages
307
Best answers
0
Hi there. I don't know much -- but I would use -74, -RT. And the 611.72 if that's what was there originally. (Can you find more info on an H+P or consult?) Did the surgeon say 'breast mass' on pre-operative diagnosis?

Also - even though the procedure was discontinued, you still used your pre-op staff, the OR staff, the supplies, the sedation, the OR for however long it took them to move the pt to post-op/PACU, etc.,..... a LOT more resources than a breast exam.

If possible, I would attach the "op note is coming" info electronically and then fax the op note to the payer; payers we deal with have a hard time with "-74" even though it is clearly the correct modifier to use for 'ASC procedure discontinued after admin of anesthesia.' The op note helps if they will take op notes....some payers will, some won't. Some of our payers will deny and THEN you can fax or send the op note with the appeal.

I don't know about using the "V64.3" - maybe someone else out there has some insight?
 
Top