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Mastectomy and reconstruction

  1. Default Mastectomy and reconstruction
    Medical Coding Books
    On occasion, our general surgeon does a mastectomy (19303) and the plastic surgeon comes in and does a reconstruction during the same session. The plastic surgeon usually bills a 19357. We have always billed for the mastectomy, but we have never billed as an assistant for the 19357. Each doctor has billed their own fees. Our doctors may or may not stay for the entire procedure after the mastectomy is performed. The plastic surgeon is telling us that we can bill the 19357 with a 80 modifier if the general surgeon stays for the entire procedure. The plastic surgeon also bills as an assistant for the mastectomy. It seems to me like this would be quite a bit of double-dipping!! I would think that if we are going to bill as assistants on each other's surgeries that our done at the same session that we would should really be billing mutual codes and bill as co-surgeons.

    It is very difficult to other offices to bill as so-surgeons, but I can't see also billing as a assisant on the reconstruction and the plastic surgeon billing as a surgeon on the mastectomy.

    How do other do this?



  2. #2
    Charleston, WV
    To bill as an assistant, the physician has to be actively involved in the procedure. Just being present does not justify billing as an assistant. in addition, the use of an assistant must be medically necessary. If there is no medical justification for an assistant surgeon, very few payers will allow it.

    As for co-surgeons, each surgeon must perform a distinct part of the same procedure. If each surgeon performs their own billable procedure, they should each bill for their respective procedure only.

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