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lnaschke

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I am having a lot of claims denied for breast recontruction. Below is a typical Claim


19342-50
19370-50,59
19301-50,59

And the notes...

"She had inferior transverse mastectomy scars which I planned to resect, so the incision was made just superior to these along the edge of the scar. This was made after infiltration of Marcaine with epinephrine. This was carried down through the AlloDerm layer after the subcutaneous layer. The AlloDerm was opened with cautery, and then sharply taking care not to damage the underlynig implant. Examination of the capsules revealed that they were thin, but without pericapsular fluid or capsular masses. Implants were intact. They were removed and placed in triple antibiotic baths.

The above described capsular manipulations were performed. This was very extensive capsular manipulation. Capsulotomies were made to allow the implant to move superomedial and these were made with extended cautery and fiberoptic lighted retractor carefully taking care not to divide any pec major muscle and to make the edges smooth for realistic result.

The capsulorrhaphies were to correct the stretched out pockets inferiorly and laterally. These were performed with floor advancement technique using a double-row capsulotomy and suturing these with 3-0 PDS buried. This was done inferiorly and laterally in a long continuous row. In addition, cautery capsulorrhaphies were performed using forceps and cautery to further tighten these very loose inferolateral pockets. Once the pockets were noted to be symmetric and hemostasis was obtained, the pockets were washed a final time with triple antibiotic solution. The implants looked excellent, so they were replaced. The AlloDenn layer was closed with buried 3-0 PDS suture taking bites through the subcutaneous tissue to cover the AlloDerm."


I have tried to let the provider know that his documentation is insufficient for the 19370 and 19301. Any Suggestions about how I could advise him to make his notes better?

Thanks in advance.
 
I was asking about the documentation. What can he do to document what he does better?
 
lnaschke said:
I am having a lot of claims denied for breast recontruction. Below is a typical Claim


19342-50
19370-50,59
19301-50,59

And the notes...

"She had inferior transverse mastectomy scars which I planned to resect, so the incision was made just superior to these along the edge of the scar. This was made after infiltration of Marcaine with epinephrine. This was carried down through the AlloDerm layer after the subcutaneous layer. The AlloDerm was opened with cautery, and then sharply taking care not to damage the underlynig implant. Examination of the capsules revealed that they were thin, but without pericapsular fluid or capsular masses. Implants were intact. They were removed and placed in triple antibiotic baths.

The above described capsular manipulations were performed. This was very extensive capsular manipulation. Capsulotomies were made to allow the implant to move superomedial and these were made with extended cautery and fiberoptic lighted retractor carefully taking care not to divide any pec major muscle and to make the edges smooth for realistic result.

The capsulorrhaphies were to correct the stretched out pockets inferiorly and laterally. These were performed with floor advancement technique using a double-row capsulotomy and suturing these with 3-0 PDS buried. This was done inferiorly and laterally in a long continuous row. In addition, cautery capsulorrhaphies were performed using forceps and cautery to further tighten these very loose inferolateral pockets. Once the pockets were noted to be symmetric and hemostasis was obtained, the pockets were washed a final time with triple antibiotic solution. The implants looked excellent, so they were replaced. The AlloDenn layer was closed with buried 3-0 PDS suture taking bites through the subcutaneous tissue to cover the AlloDerm."


I have tried to let the provider know that his documentation is insufficient for the 19370 and 19301. Any Suggestions about how I could advise him to make his notes better?

Thanks in advance.
Click to expand...

The codes billed here were not performed. If he did bilateral partial mastectomies (19301-50) they were not mentioned. But, had they been, it would be immediate breast reconstruction with implant (19340-50), not delayed (19342-50). If no mastectomy was performed, 19342-50 would be appropriate but, the capsulorraphies (19380-50) would be incidental, as would the capsulotomies (19370-50). I believe this is the reason for your denials.
 
that is what I thought, but he did remove excess breast tissue, would that also be bundled? or, is there another way he could document what he did? if he removed 25cm x 5 cm of breast tissue, shouldn't he be able to be reimbursed for that? He usually documents the dimensions in list form on the first page of the ops notes.
 
lnaschke said:
I was asking about the documentation. What can he do to document what he does better?
Click to expand...
I go through the same with the physician who I do claims for. The reports don't add up to what codes they use. Can explain until the cows come home. I'm going on 6 years now. Delay in revenue.
 
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