# reduction mammoplasty combined with lliposuction



## bench (Sep 7, 2012)

hi,

When a reduction mammoplasty ( 19318) was done and after the excision of tissues liposuction (15877) was also performed to achieve symetry, would you code the liposuction separately or this is considered as an inclusive procedure.

Thanks for your input.


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## RainMaker (Sep 8, 2012)

bench,

I suspect some carriers would consider a separately reported liposuction procedure as cosmetic, and so perhaps not reimbursable. If I were you, I would check with the carrier for their specific guidelines, but I'll guess your reimbursement would only come from the reduction mammoplasty code.

As far as getting additional reimbursement for the liposuction, the thought of appending modifier 22 crossed my mind, but that would require the liposuction documentation and besides that, my understanding is that this modifier is generally overused and attracts scrutiny. Because of this, if possible, an additional procedure should be specified instead of using 22. So that brings us full circle to the original conundrum.


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## bench (Sep 10, 2012)

Thanks for your input. As you know rarely responds to inquiries. I just wanted to get some more ideas about this type of combined procedure. Reading the lay description for code 19318 states the excision of breast tissues, and adipose tissue is also part of the breast tissue. Its just the way it was taken out by liposuction. I have already read the medical policy guiidelines for certain payer and all they say is if the liposuction was the sole approach then it will be denied as cosmetic. It is just kind of confusing because for abdominoplasty procedure when liposuction was done it is inclusive unless of course if its a different site or incision. Actually what I want to find out is if all open procedure when accompanied with liposuction is inclusive. So far I dont get any definite answer as untill now I am not finding any article or topic about this. Thought of mod 22 but it wont seem to fit with the dictaion. Also the op-report did not specify any type of difficulties, additional amount of time than usual, or sevirity of patient condition...etch...

My main concern is compliance. Do I really need to report 19318 with 15877 or just 19318. I am not sure if reporting them both is over coding or under if I dont. 

Thank you very much for your contribution. Appriciate it.


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## RainMaker (Sep 10, 2012)

bench,

Was the 19318 considered medically necessary? (e.g., for back problems)


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## bench (Sep 11, 2012)

Hi,

Yes, back pain, neck and shoulder pain. But aside from these there are still more criteria to meet the medical neccesity for breast reduction like pre operative evaluation by the md for the tissue to be removed based upon per body surface area.....you will need to visit the payers medical guidelines for more info. FYI


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## RainMaker (Sep 11, 2012)

Of course not knowing the details of the case I can't say what to code definitively, but it sounds to me like only one procedure was performed, 19398, and that the liposuction activity was simply "tidying up" the reduction, and so part of 19398. (In other words, I doubt a physician would perform a reduction and leave the breasts with an awkward appearance; that would not make for a happy customer ). This would especially be true if the asymmetry were an iatrogenic result of the procedure (i.e., the reduction caused the asymmetry). 

In my mind, reporting additionally 15877 makes it sound like two distinct procedures were done -- the reduction for back pain, and a cosmetic procedure for asymmetry that existed beforehand, and the procedure was discussed and elected by the patient in the pre-op consultation. You might want to review the pre-op notes for this.

Thoughts?


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## bench (Sep 11, 2012)

That is true reduction 19318 for the reduction and liposuction 15877 for symetry. Some payer may pay both and some may not as they may look at the 15877 as cosmetic. But what I am really trying to find out here is if these two codes can actually be reported together and not an over coding. I have actually had billed these before and was both paid. But I got a complained later on by the MD saying that these codes should not be billed together as they are inclusive. Ive used ncci edits on my coding and since these 2 are not component of each other I billed both. A lot of factors that you need to consider like patients payment will be affected, they may become responsible for the entire charges or if the procedures got paid their co insurance portion will go up. I am not actually after the reimbursement, I just want to make sure that the codes I come out with is correct. I am just kind of consfuse about the lay description for 19318 with the excision of breast tissue because lipo was also done to take the fat (adipose tissue) out from the breast that is why I wanted to take you fellows perception about this matter. 

Thanks for looking!!!!!


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## RainMaker (Sep 13, 2012)

No problem. Let me know how it works out.


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