Wiki Reshaping and Redraping Breast Reconstruction

[dkward]

I need an opinion,

Surgeon did a breast reconstruction for post masectomy. The surgeon codes their own claim (yuk) but what can you do?

The procedure I need an opinion about is dictated as "Extensive reshaping of bilateral breast with redraping of native breast skin flaps and reshaping of latissimus flaps".

The Surgeon used an unlisted code of 19499 but the issue I have with this is no one authorized the code with the insurance prior to the procedure and it is unlisted. It is highly unlikely the code will get paid.

So, could it be coded with 19366 (Breast reconstruction with other technique) with a -22 modifier (since the surgeon dictated detail as extensive) and a -50 modifier since it was bilateral?

 

[mzemla309]

Since you state "reshaping of latissimus flaps," does that mean she previously had breast reconstruction with latissimus flaps? If that is the case I would code 19380-50.

If this is the initial surgery, 19366 I think would be better but I don't think it warrants a -22 modifier. The -50 modifier would be correct if performed bilaterally.

 

[dkward]

AHH! I think you are right. I didn't even notice that she did not code the recontruction. Yes the patient had the latissimus flaps previously.

I also think a modifier -22 would be appropriate since she did dictate the length of time it took to do this.

The surgeon must obvioulsy think that since there was extensive time taken, it would be coded as unlisted.

Thanks!