Wiki Removal of tissue expander

[KatiWhite]

I need help!

My doc removed tissue expanders on a breast cancer patient as there were toooo many complications for her. He did not replace them. I billed CPT 11971 Removal of tissue expander(s) with out insertion of prosthesis with modifiers LT and RT. Medicare denied one side and said that this code cannot be billed bilaterally. Should I have used 19328 Removal of intact mammary implant?

Thanks Kati Telliard, CPC

 

[FTessaBartels]

Expander(s)

I think the key here is that little parenthetical (s) at the end of Expander.

Funny though, the lay description reads: The physician removes a subcutaneous tissue expander without placing a prosthesis or performing final reconstruction. Initially, the tissue expander is deflated. The physician uses a scalpel to make an incision. Blunt dissection is used to remove the tissue expander. A surgical drain may be placed in the wound. The incision is closed with sutures.
This clearly indicates a singular removal.

The code does not accept a -50 modifier, but does accept a -59 modifier.

I'd try to appeal using 11971, and 11971-59. If that still doesn't work, you may need to consider 11971 with a 22 modifier for the additional work of a separate incision.

I had a case some years ago with a pediatric patient and a commercial payer. The child had 3 tissue expanders. The payer kept responding "you should only have 1 code per day" I sent photos, clinic notes and operative notes that clearly showed there were 3 separate expanders, and finally convinced them that subjecting the patient to the risk of general anesthesia 3 separate times was unconscionable. They finally paid ... but it took over a year from date of service to payment.

Hope that helps, and good luck.

F Tessa Bartels, CPC, CEMC