Could someone please help me? My surgeon done a bilateral partial mastectomy with axillary lymphadenopathy for a woman with bilateral breast cancer. I have tried to code it multiple ways, and I have denials from only 1 of these is allowed per day, to incorrect modifier. I have tried to code it on 2 lined with a left and right modifier, tried 1 line wit 1 and a 50. The last time I used 78, 50 and 59. The 78 because she had the breast biopsy a few weeks earlier. I have never had so much difficulty. If someone could help me I would greatly appreciate it. Thank you in advance
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Wiki Bilateral partial mastectomy
- Thread starter aprilk65
- Start date
It might be getting denied because some insurance companies don't like modifier 50. Also, if the biopsy was performed a few weeks earlier by the same provider (or group) then a modifier will be needed to bypass the global surgery edit. I would suggest using modifier 58 because technically this is a staged procedure. I'm assuming that the provider would have been planning a partial mastectomy depending on the results of the biopsy.
With the limited information that you've provided, I would suggesting coding it as follows:
19302 -58,50
OR
19302 -58,RT & 19302 -58-59-LT
With the limited information that you've provided, I would suggesting coding it as follows:
19302 -58,50
OR
19302 -58,RT & 19302 -58-59-LT
I'd also be sure that you're using 2 diagnosis codes - one for the right breast and one for the left breast. Insurers are getting more savvy about laterality in diagnosis codes.
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