Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.
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1. Liposuction of the breast to achieve breast reduction is reported with CPT code 15877 and not 19318.
2. Although carrier policies may differ, the intent of CPT code 15877 is for this code to be used one time for each different area where liposuction is performed on the trunk.
3. A "corset" platymaplasty is the midline plication of the platysma muscles under the chin and down the neck. This type of procedure would not be reported as a bilateral procedure because it is performed in the center of the neck and not on each side.
4. A Wise Pattern "keyhole" procedure can be performed as a mastopexy or breast reduction procedure. When a keyhole pattern is developed and the nipple is transposed to a higher location lifting the breast, this would be a mastopexy procedure. If substantial amounts of tissue are removed from each side of the breast before transposing the nipple this would be a reduction mammoplasty.
5. Removal or grafting of the nipple complex is not considered part of a typical reduction mammoplasty, so in instances when the nipple and areola are harvested as a free graft and reattached to a new site CPT code 19350-52 should be reported separately.
6. When a permanent tissue expander is left in place and only the filling port is removed the appropriate code to report would be 11971-52 – removal of the tissue expander without insertion of a prosthesis with the reduced service modifier.
7. The terms lumpectomy, tylectomy, quadrantectomy, and segmentectomy are synonymous with a partial mastectomy. A lumpectomy is the excision of a breast mass with particular attention paid to the surgical margins (adequate resection of normal tissue in addition to the mass). Since the terms lumpectomy or partial mastectomy are interchangeable the correct code for this procedure is 19301 partial mastectomy.
8. In addition to the partial mastectomy an axillary lymphadenectomy can be performed to diagnose the presence of cancer. CPT code 19302 (with axillary Lymphadenectomy) is only reported when all of the axillary lymph nodes are removed. Sometimes when performing a mastectomy a few lymph nodes may be excised and that is reported with a lymph node excision code.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read more insight from Paul Cadorette:
- 8 ASC Coding Tips for Orthopedic Procedures
- Coding for Screening Colonoscopy When There is Rectal Bleeding