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How would you code this?

  1. #1
    Location
    Daytona Beach, FL
    Posts
    748
    Default How would you code this?
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    Hoping someone can answer this for me...My surgeon did a Modified Radical Mastectomy and listed the Plastic Surgeon as his assistant. The Plastic Surgeon was there actually to perform a reconstruction of the breast if the tissue was viable. After the mastectomy it was determined that there was too much damage from previous surgery and radiation to do an immediate reconstruction, so this procedure was not performed and the Plastic Surgeon sutured the surgical wound.

    How would I code the plastic surgeon's portion? Would I code it as an assit to the procedure with the -80 modifier, or would I bill the reconstruction code with the -53 modifier?

    Thanks,
    Jodi Dibble, CPC

  2. Default
    Yes I too feel that way of -53 for the plastic surgeons bill and of course with Vcode V64.1 or V64.3 plus detailed report from the palstic surgeon to indicate why it could not be continued finally .

  3. #3
    Location
    Daytona Beach, FL
    Posts
    748
    Default
    Thanks for responding. Just so I have this clear, the correct way to bill for the Plastic Surgeon would be to code the intended reconstruction CPT code with the -53 modifier rather than just billing the Mastectomy procedure with the assistant modifier of -80?

    Thanks,
    Jodi Dibble, CPC

  4. #4
    Location
    Kansas City, MO
    Posts
    431
    Default
    I am not sure I agree. I'm not positive on my point either but here are my thoughts.

    From what you shared...the plastic surgeon (PS) did not ever attempt a reconstruction...so I don't feel the 53 is appropriate. I am gonna assume after the mastectomy the PS did do some looking at the area and then decided not to do the reconstruction??
    Essentially, the PS did the closure...of which payment is inclusive of the mastectomy...so I'm kinda thinking the assistant version (mod 80) might be more appropriate.

    Unless there is more to the op and the PS actually did more than "peek and sew"??

  5. #5
    Location
    Fayetteville, NC
    Posts
    300
    Default
    I too lean the same way as LINDALOUV I would bill the mastectomy code with an 80 modifier as the closure is part of the actual mastectomy procedure.
    If he didn't even attempt the reconstrcution then billing it with the -53 would in my opinion be inappropriate.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  6. #6
    Location
    Daytona Beach, FL
    Posts
    748
    Default
    Thanks Linda and A. McCormick - I think what you say makes more sense. I was initally heading towards coding it that way, but thought I would get some help to be sure I was thinking right!

    From the notes by both doctors, the plastic surgeon only did the "peak and sew"! She did not document any other steps that were done, so I will bill her as the assistant.

    Thanks again to everyone for their help.
    Jodi Dibble, CPC

  7. #7
    Location
    Fayetteville, NC
    Posts
    300
    Default
    You're welcome!!
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

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