tci General Surgery Coding Alert - 2010 Issue 3

READER QUESTIONS: Check for Separate Capsulectomy

Question: When our surgeon performs second stage breast reconstructions, he often performs a capsulectomy as well. Should we consider these different procedures, even though they're at the same site through the same incision? Can we code both using 11970 and 11971-59? Texas SubscriberAnswer: No, you should not consider these separate procedures. The situation you describe does not meet the standard for separate billing. The Correct Coding Initiative (CCI) edits bundle 11970 (Replacement of tissue expander with permanent prosthesis) and 11971 (Removal of tissue expander[s] without insertion of prosthesis) as a mutually exclusive pair. Although the CCI modifier indicator allows...

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