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Unilateral Breast Reconstruction

  1. #1
    Adirondack Chapter of Professional Coders, Glens Falls, NY
    Question Unilateral Breast Reconstruction
    Medical Coding Books
    I work for two Plastic/Reconstructive surgeons and they bill quite frequently for breast reconstructions. I have finally got them to stop using modifier -50 on these codes as they are bilateral to begin with, but we cannot agree on how to bill the codes if the procedure was only done on one breast. They say to use either -RT or -LT depending on which breast they did the surgery on. I say to use modifier -52 for reduced services. Who is correct? Or does it depend on insurance preference? Or would you code both the -52 and either the -RT or -LT?? Help!!!

  2. #2
    Milwaukee WI
    Default Reconstruction DOES take 50 modifier
    Which breast reconstruction codes are you referring to that are inherently bilateral? The parenthetical directive immediately under the title Repair and/or Reconstruction (pg 80 of 2011 CPT Professional Edition) states To report bilateral procedure, report modifier 50 with the procedure code (emphasis added by FTB)

    Therefore, if the procedure is performed on only one breast you simply report the code. If it is performed bilaterally, you append mod 50 (or RT, LT, depending on carrier preference).

    Hope that helps,

    F Tessa Bartels, CPC, CEMC

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