Bilateral Diagnosis Coding and Bilateral CPT Coding for Breast Reconstruction

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October 8, 2015

Question:

If I use the new ICD-10-CM code for acquired absence of the breast (Z90.13), do I still need to use the CPT modifier 50 for bilateral procedures when I bill for breast reconstruction procedures (e.g., 19357, 19364)?

Answer:

Good question! Changing diagnosis coding systems from ICD-9-CM to ICD-10-CM does not change anything about CPT coding. The CPT coding system does not change at all with our change to ICD-10-CM for diagnosis coding. So, yes, you will still use modifier 50 or RT/LT or whatever modifiers you were using prior to October 1 to accurately report the bilateral procedure.

*This response is based on the best information available as of 10/08/15.

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