Removal of mammosite balloon

[CANDERSON]

Can we charge to have this removed? The code that the department is using 19499.

 

[astuart@pmsia.com]

Yes and No

It all depends on who put the balloon in. The code used to insert the balloon includes the removal so if it is the same physician who inserted the balloon, you definitely cannot bill for the removal. If a different physician inserted it, you can bill for the 19499 for the removal and we have had some success with this with the submission of records specifically stating that there were two separate physicians. I would suggest adding an addendum to your claim stating that "additional information available upon request". This way the insurance companies will request and review the records before denying it which decreases the turn around time. Otherwise they will straight deny and you will have to submit an appeal.

This all being said, be very careful if you use this as you are also stating that the physician who inserted the balloon is not completing their procedure. At one facility that I manage, an insurance company question the surgeon which can cause strain on coordination of care. The radiation oncologist should really decide if it is worth the few bucks that they will receive to not just take it out and consider it a good deed. Some physicians bill the 19499, some remove without reimbursement, and some will send the patient back to the surgeon for removal.

Alanna M Stuart BS RT(R)(T), CPC, ROCC, CHONC
Administrative Director
Physicians Management Services of Iowa
1097 Longfellow Dr.
Hiawatha, IA 52233
319-286-3763
astuart@pmsia.com