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Thread: Please help with coding Modified Radical Mastectomy

  1. #1

    Default Please help with coding Modified Radical Mastectomy

    AAPC: Back to School
    Hi Just wondering if I could get some help coding
    the following Lt Modified radical Mastectomy with Lt sentinal lymph node bx x 2
    I was looking at the 19307, 38500 and 38792 however the 38500 is bundled and CCI states that I could use a modifier just not sure how to do this. Would I use the 58 modifier as the 59 is separate and distinct PLEASE HELP
    TIA Deb,CPC

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    19307 includes the taking of the lymph nodes.

    IF this is a RARE situation where you did the sentinal node bx, and then do to results of that your surgeon decided to do the MRM, then you could try to bill using the -58 on the 19307, since it was done as a result of the first procedure. prepare for a fight on this one. The ins co will try to bundle, so you may have to appeal, but I have had luck winning on this with a written appeal. The op should really support that the pt was there for LN bx, and that after this a decision had to be made to do a more extensive procedure.

    MOST procedures will not meet this criteria...and like I said, the LN's are inclusive of the MRM.

  3. #3


    Thanks so much for your response. It really has helped me out.
    Deb, CPC

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