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mastectomy for CA with prophylactic mastectomy

  1. Default mastectomy for CA with prophylactic mastectomy
    Clearnace Sale
    We did a primary mastectomy (19307-RT) for CA (174.5) and a prophylactic mastectomy on the other side (19303-51-LT) for benign breast mass (611.72). This was denied, but we are not sure why. Should the diagnosis code for the prophylactic mastectomy be V50.41? Also, could problem be with the modifiers? Insurance company isn't saying, and we can't see anything wrong with it.

  2. Default
    Some insurance carriers will not pay for prevenative removal of the other breast. Was there any documentation that there was anything wrong with the other breast,? We always get a waiver signed for the removal of the non- cancerous breast in case the insurance carrier denies for diagnosis.

  3. Default
    Thanks for input. We're going to call her carrier and check on that.

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