# Gynecomastia



## bethh05 (Sep 17, 2013)

The physician's op note describes removal of lesion on a male patient, he does not dictate removal of any other tissue. The path states it is gynecomastia. Can anyone offer any insite on 19120 vs 19300? The insurance requested the op/path and denied the claim-19300 was billed. Thank You!!


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## Jennallen (Sep 17, 2013)

If the pathology stated Gynecomastia, then you have to code it with the 19300.  Since you didn't authorize for excision of Gynecomastia it will most likely get denied unless you can prove that it was medically necessary to remove it.

When we do a mastectomy for removal of gynecomastia, we have to send pictures and all documentation to get this approved.  In most cases it is not approved.


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## Jennallen (Sep 17, 2013)

If the pathology stated Gynecomastia, then you have to code it with the 19300.  Since you didn't authorize for excision of Gynecomastia it will most likely get denied unless you can prove that it was medically necessary to remove it.

When we do a mastectomy for removal of gynecomastia, we have to send pictures and all documentation to get this approved.  In most cases it is not approved.

19120 is only used for breast masses malignant or benign.


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## BEARDOG (Sep 17, 2013)

bethh05 said:


> The physician's op note describes removal of lesion on a male patient, he does not dictate removal of any other tissue. The path states it is gynecomastia. Can anyone offer any insite on 19120 vs 19300? The insurance requested the op/path and denied the claim-19300 was billed. Thank You!!



19120 is an excisional biopsy.  The entire mass is removed but nothing else.  No attempt is made to get adequate margins, only the mass itself is removed. 

19300 is a mastectomy for gyencomastia, extraneous fat and breast tissue are dissected from the pectoral fascia and removed.  It is a much more involved procedure and more tissue is removed and goes deep to the pectoral fascia.  A lot of carriers consider this a cosmetic procedure and will not pay for the procedure.  It sounds like from your description that a breast biopsy was done, not a mastectomy. Also, 19300 is for males only, 19120 can be used for males or females.  I hope this helped.


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## bethh05 (Sep 17, 2013)

Thank you very much for the help. I think this was more of an incidental finding, as the physician dictated "breast mass." I will try rebilling with 19120 and dx 611.1, which will probably get denied.


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## BEARDOG (Sep 18, 2013)

That is the correct coding, you should not get denials for that. I have done several and have not had any problems.  If it was a private carrier and it was not pre-certified then you may have some difficulty. If it is a medicare pt you should not have any problems. 
Good Luck!


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