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
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