Wiki practicode says I needed -50 - for a breast reduction??

[The Angel Of the South]

For practicode, I had to code a breast reduction (Dx: bilateral macromastia). I got the ICD-10 and CPT codes right, but not the CPT modifier. Why is the rationale saying I need to code -50? I thought the code must be inherently bilateral and I therefore should not use -50. When wouldn't both breasts be reduced? Are there conditions that hypertrophy only one breast?

 

[sls314]

For practicode, I had to code a breast reduction (Dx: bilateral macromastia). I got the ICD-10 and CPT codes right, but not the CPT modifier. Why is the rationale saying I need to code -50? I thought the code must be inherently bilateral and I therefore should not use -50. When wouldn't both breasts be reduced? Are there conditions that hypertrophy only one breast?

Assume that a CPT code is unilateral unless the definition of the code specifically states that the code is considered bilateral.

Example - 32853 is "Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass." Bilateral is specifically stated in the definition of the code.

There could be reasons why a doctor would only perform a procedure on one breast. I understand being curious about it, but in the long run that rabbit hole is outside our scope as a coder.

 

[sls314]

If you wanted to learn a little more about bilateral procedures, you could read up on the Bilateral Indicators used on the CMS Physician Fee Schedule.

Note: this is more in depth than what you need to know for Practicode or taking an exam, so you don't have to worry about memorizing it or learning it now. Especially if your brain is on information overload right now.

I'm just letting you know some of the information that's out there, because it can be useful for some jobs down the road. Depending on your job duties and what setting/specialty you work in.

Here's a link from Novitas that explains the definitions of bilateral indicators: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00150901

Here is a link to the CMS Physician Fee Schedule Lookup Tool:

https://www.cms.gov/medicare/physician-fee-schedule/search/overview