Billing Bilateral Procedures

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April 14, 2016

Question:
I was hoping you could answer a quick coding question for me. For example, in bilateral coding a breast reduction (19318) or a TRAM flap (19367), do I put the codes on one line or 2? Example: 19318-50 or 19318 and 19318-50.

Answer:
The charge entry format depends on the payer preference. Medicare prefers 19318-50 (one line, 1 unit, double your single fee) while some other payors want 19318 (one line, 1 unit, your single fee) and 19318-50 (second line, 1 unit, your single fee). It’s best to contact the payor to determine their preference. First check on-line in their provider billing manual – usually the preferred format is described there. Attend one of our plastic surgery coding courses by clicking here. Hope to see you there!

*This response is based on the best information available as of 04/14/16.

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