tci General Surgery Coding Alert - 2011 Issue 7

Reader Question: Gynecomastia Earns 19300

Question: Our surgeon performed a mastectomy on a male patient with a suspicious breast mass. The final diagnosis was gynecomastia. Must we bill the procedure as 19300, or can we bill 19303 since the surgeon didn't know the diagnosis before the surgery?Missouri SubscriberAnswer: Without further documentation, you would need to code this case as 19300 (Mastectomy for gynecomastia) instead of 19303 (Mastectomy, simple, complete).If the surgeon provides some documentation regarding why he thought the breast mass needed to be removed, such as an abnormal fine needle aspiration or biopsy, you could code the procedure as 19303.But...

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