michelledc
Networker
Medicaid is denying a claim because patient is a male and they say that 19303 is gender specific to female. I don't see that anywhere. Does anyone know where I can find it for sure?
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Wiki 19303 gender specific?
- Thread starter michelledc
- Start date
lgardner
Guest
just looking in my CPT book, it seems that there is a different code (in the same section) for males: 19300 - mastectomy for gynecomastia (which is for males), with a note that states "for breast tissue removed for a breast-size reduction for other than gynecomastia, use 19318"
it is, also, noted under 'Mastectomy Procedures' - (with the exception of gynecomastia - 19300) mastectomy procedures are performed either for treatment or prevention of breast cancer.
I do not see anything else that mentions male or female, but if the male pt did not have breast cancer, that could be why it denied.
it is, also, noted under 'Mastectomy Procedures' - (with the exception of gynecomastia - 19300) mastectomy procedures are performed either for treatment or prevention of breast cancer.
I do not see anything else that mentions male or female, but if the male pt did not have breast cancer, that could be why it denied.
I'm guessing the real issue is also related to the diagnosis. From what I see 19303 is for the treatment or prevention of breast cancer.
If that is not the case, another CPT could be more accurate.
If this is regarding a transgender patient, also review modifier -KX.
If that is not the case, another CPT could be more accurate.
If this is regarding a transgender patient, also review modifier -KX.