Wiki 19371 billed with 19380

[tinaval]

We got a denial from BCBS when we billed these two codes together. Our billing software program doesn't show them bundled or incidental to, but that is the denial reason we are getting. We just starting billing for Plastic surgery in March so I'm not too sure abut this one. Does anybody have any suggestions, any help would be appreciated.

 

[Kiana]

This isn't a bundling issue unless they think its being done on the same breast.

 

[tinaval]

Should I be embarressed to say it is the same breast???? So If the Doctor does 19380,(revision of reconstructed breast) would the assumption be the 19371 (capsulectomy) is not separately billable?

 

[terridiaz]

What kind of "reconstruction" did he do on the breast, besides the capsulectomy?

 

[tinaval]

He did a 19380 (reconstruction to correct a problem for asymmetry).

 

[terridiaz]

I would appeal with the operative report.

 

[tinaval]

Thank you for all your help.

 

[docndent]

Most payers bundles these since they see the capsulectomy as the approach to the reconstruction. I agree that you have to send the op report but they may still not pay for it.