Advanced Search

General Surgery Coding Alert

You Be the Coder:

Modified Radical Mastectomy

Published on Sat Dec 01, 2001

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.

Question: What is the appropriate coding procedure when the general surgeon performs a modified radical mastectomy and then turns the patient over, intraoperatively, to the plastic surgeon? I have been told that I need to append modifier -52 to 19240 because my surgeon will not be closing the patient. Is this correct?

Maine Subscriber

 
Answer: No. The surgeon completed the 19240 (mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle) but did not close because the plastic surgeon immediately began to work on the patient. When modifier -52 (reduced services) is appropriately used, it signifies that the procedure was modified to a lesser extent. This is not the case here. Furthermore, if the surgeon were to append modifier -52 because he or she did not close the patient, then logic would dictate that the plastic surgeon would also have to append the same modifier because he or she did not open the patient. Coding is already complicated enough without unnecessarily adding more twists. In short, bill the procedure without modifier -52.

Other Articles in this issue of

General Surgery Coding Alert

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.