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no breast mass - modifer 74

  1. #1
    Default no breast mass - modifer 74
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    Patient had MAC anesthesia, was bought to operating room , was examined , could not find a papable mass , so a decision was to abort the procedure. . Operative report stated breast exam. Surgery was booked at our ASC as -Excision of breast mass -cpt code 19120
    .. ,
    in operative note it stated patient will be scheduled next
    for radiologic imaging and next incision will be a radiologic need localization -which IS CPT CODE 19125-
    Now here is my question ?
    DO i code 19120 rt with modifer 74 now with dx code v64.3 and what was also 611.72 that was on the booking
    or breast exam which I dont think is right, any suggestions please bring them on .THANKS
    Last edited by codedog; 08-18-2010 at 02:17 PM.

  2. Default
    Hi there. I don't know much -- but I would use -74, -RT. And the 611.72 if that's what was there originally. (Can you find more info on an H+P or consult?) Did the surgeon say 'breast mass' on pre-operative diagnosis?

    Also - even though the procedure was discontinued, you still used your pre-op staff, the OR staff, the supplies, the sedation, the OR for however long it took them to move the pt to post-op/PACU, etc.,..... a LOT more resources than a breast exam.

    If possible, I would attach the "op note is coming" info electronically and then fax the op note to the payer; payers we deal with have a hard time with "-74" even though it is clearly the correct modifier to use for 'ASC procedure discontinued after admin of anesthesia.' The op note helps if they will take op notes....some payers will, some won't. Some of our payers will deny and THEN you can fax or send the op note with the appeal.

    I don't know about using the "V64.3" - maybe someone else out there has some insight?

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