Wiki 19301 lumpectomy

[astephens]

In our practice, our surgeons occasionally perform more than one lumpectomy either same breast or opposite. Medicare has a MUE of 1 unit, my question is do you see this scenario in your practice? if so, how are you fighting your denials?
Thanks in advance for your input.

 

[dkissel]

Per CMS, you may bill the bilateral modifier 50 on 19301 for one in each breast. As for two separate excisions on the same breast, you would have to use modifier 59 on the second procedure and appeal with your documentation. I have had success in doing this with our breast surgeons who've come across this scenario.

 

[melody.ongenae@gmail.com]

Thank you!