medsolutions
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We're billing a bilateral DIEP flap (breast reconstruction) with modifier 59 on the opposite breast, our argument is that the surgeon needs to perform a separate incision and a separate reconstruction on the opposite breast. However, the insurance company is paying it as if we had used a 51 or a 50 modifier. They pay 100% on the first breast and only 50% on the second. Am I wrong, in thinking that modifier 59 is not only appropriate but he is entitled to get reimbursed at 100% for both, since basically he has to do the same surgery twice. Can someone enlighten me?