tci General Surgery Coding Alert - 2012 Issue 8

Reader Question: Modifier 50: Know When "Times 2" Won't Fit the Bill

Question: Our surgeon performed a bilateral mastectomy for a Medicare patient. The right breast had cancer, but the left breast was removed prophylactically. I billed 19307 x 2 with diagnoses codes 174.9 and V50.41. Is there any way to get this claim paid? New Jersey Subscriber Answer: Medicare expects you to bill bilateral procedures using modifier 50 (Bilateral procedure), so the problem may be that you billed 19307 x 2 (Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle). Do this: Bill the service as 19307-50, listing your...

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