General Surgery Coding Alert

Reader Questions:

Unravel Bilateral Breast Coding Conundrum

Published on Thu Dec 16, 2021

Question: We received a Medicare denial for a claim involving two units of 19083 with modifiers LT and RT because the surgeon performed the procedure in each breast. What is the reason for the denial, and what should we do differently?

Tennessee Subscriber

Answer: The bilateral surgery indicator of “1” indicates you can bill 19083 (Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance) as a bilateral procedure.

However, the CPT^® code book instructs you to report one unit of 19083 for bilateral services. You should then report one or more units of +19084 (…each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) for the contralateral breast and all additional lesions.

MUE: You should also notice that 19083 has a MUE of 1, which means that only one unit of 19083 may be submitted to the payer on a given date of service (DOS).

When you submit 19083 on separate lines with modifiers LT (Left side) and RT (Right side), the Medicare system flags the claim for invalid CPT^® code frequency. Although you may override denials such as this by submitting the code with modifier 50 (Bilateral procedure) in some instances, that is incorrect for this case due to the previously mentioned CPT^® instruction.