Wiki S2068 Dx Coding

ashleynting

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Hello :)

I've just started a position with a plastic surgeon's office specializing in DIEP after mastectomy, and am trying to figure out an issue they are having with BCBS recoupments. I'm thinking it has to do with the non-cancerous/prophylactic side (most patients have double mastectomy and reconstruction even for unilateral cancer). They have been billing S2068 RT and LT, but pointing the prophylactic side to the ICD code C50.91* indicating the cancerous side (i.e. S2068 RT pointing to C50.912).

Sometimes the claims pay fine at first, then BCBS is recouping the payment for the prophylactic side stating diagnosis mismatch (understandable). We are also billing with ICD codes Z42.1 and Z15.01, however the surgeon does not believe that these are strong enough on their own to support the prophylactic reconstruction. But we can't bill the C50.91* for the non-cancerous side, correct?

Thanks in advance for any help!
 
Also, I have suggested using Z90.1*. They say they've tried that as well without success. We are pulling one claim and just planning on doing corrections one change at a time until something works, and pointing the prophylactic side to Z90.1* is on my list. My other suggestion was to code as S2068-50.
 
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