Wiki removal br impl materil, insert new br prosthesis

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MRENATE

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Insurance: Medicare
This patient is post-bil mastectomies in 1993. Presents in 2009 with seroma and broken implant on rt and broken impl. on left. Procedure: removal of silicone material, evacuation of rt. breast seroma, insertion of new Mentor smooth prosthesis; on the lt: removal of silicone material and insertion of prosthesis.This was coded as CPT 19330-50 removal impl. material, bilaterally, 19340-50 immediate insert. of br prosthesis bil. in reconstruction, 10140 evac. of seroma rt breast. Medicare paid for 19330 and 10140. They deny 19340, saying it is an add-on code and there is no primary procedure listed. Should we have billed 19342 delayed insertion? How are the add-on codes identified in the CPT book now? They used to be highlighted as such. ICD9 codes used were:611.71 mastodynia, 996.54 br. impl. complications, V10.3 pers. history br. cancer, 998.3 for the seroma. Any suggestions on how to get Medicare to pay for insertion of the implants? It was not a cosmetic procedure in this patient who is status post bil. mastectomies for breast cancer. Thanks MRENATE
 
MRENATE said:
Insurance: Medicare
This patient is post-bil mastectomies in 1993. Presents in 2009 with seroma and broken implant on rt and broken impl. on left. Procedure: removal of silicone material, evacuation of rt. breast seroma, insertion of new Mentor smooth prosthesis; on the lt: removal of silicone material and insertion of prosthesis.This was coded as CPT 19330-50 removal impl. material, bilaterally, 19340-50 immediate insert. of br prosthesis bil. in reconstruction, 10140 evac. of seroma rt breast. Medicare paid for 19330 and 10140. They deny 19340, saying it is an add-on code and there is no primary procedure listed. Should we have billed 19342 delayed insertion? How are the add-on codes identified in the CPT book now? They used to be highlighted as such. ICD9 codes used were:611.71 mastodynia, 996.54 br. impl. complications, V10.3 pers. history br. cancer, 998.3 for the seroma. Any suggestions on how to get Medicare to pay for insertion of the implants? It was not a cosmetic procedure in this patient who is status post bil. mastectomies for breast cancer. Thanks MRENATE
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Well not sure why they denied as an add on code. That is certainly NOT an add on code first of all.
Second I think you billed this correctly so I would call them to see exactly why they denied this, tell them you don't understand their denial because this is not an add on code procedure. Then if they don't say they processed this wrong then I would appeal this and show documentation because I think they processed this claim wrong.
 
Tinaboe

Hello,

I actually had the same problem with Medicare not paying for the implant placement stating the code 19340 was an add-on. I received guidance from the ASPS stating that if the insurance carrier denied this code to use the code 19342.
 
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