VickieArballo
Contributor
Hello everyone. I am coding for a breast surgeon who does partial mastectomy (19301) for malignancy and then does either a mastopexy (19316) or an adjacent tissue transfer (14001) to achieve a good appearance outcome for the patient. According to CCI edits there are no conflicts for these codes, however they are not being reimbursed because 14001 includes "Excision (with or without lesion) with repair by adjacent tissue transfer or tissue rearrangement Size includes primary (due to excision) and secondary (due to flap design)Z-plasty, W-plasty, VY-plasty, rotation flap, advancement flap, double pedicle flap, random island flap" and the intent of 19316 is aesthetic and described as "The physician performs a breast lift, or mastopexy, relocating the nipple and areola to a higher position and removing excess skin below the nipple and above the lower breast crease. The physician makes a skin incision above the nipple, in the location to which the nipple will be elevated. Another skin incision is made around the circumference of the nipple. Two skin incisions are made from the circular cut above the nipple to the fold beneath the breast, one on either side of the nipple, forming a keyhole shaped skin incision. This skin is cut away from the breast tissue and removed. The physician elevates the breast to its new position and closes the incision, excising any redundant skin in the fold beneath the breast. The incision is repaired with layered closure."
My physician is spending twice the time on these cases vs. what she would if she did a simple partial mastectomy. Adding a modifier 22 and sending with report and request for additional reimbursement has not worked either. I am in California. I would appreciate any advise on how to code this type of repair to get her paid for the work she is doing. I feel like I may be missing something.
The Medicare reimbursements in this locality are as follows: 19301 = $683.13 19316 = $810.82 and 14001 = $663.75
Thank you,
Vickie Arballo, CPC, CPB
My physician is spending twice the time on these cases vs. what she would if she did a simple partial mastectomy. Adding a modifier 22 and sending with report and request for additional reimbursement has not worked either. I am in California. I would appreciate any advise on how to code this type of repair to get her paid for the work she is doing. I feel like I may be missing something.
The Medicare reimbursements in this locality are as follows: 19301 = $683.13 19316 = $810.82 and 14001 = $663.75
Thank you,
Vickie Arballo, CPC, CPB