Closure After Lumpectomy

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May 15, 2014

Question:

I will frequently do a Wise pattern breast reduction on a breast after a lumpectomy; then I do a breast reduction on the contralateral breast. Is it appropriate to report code 19318 (Reduction mammoplasty) or should I use 19366 for Breast reconstruction with other technique? Or maybe I can use both codes for each side?

Answer:

Actually, 19366 cannot be used in your scenario because a mastectomy was not performed. The breast reconstruction codes are used only for reconstruction after a mastectomy procedure and not for closure of a lumpectomy defect. Therefore, you will use only 19318 with modifier 50. Remember, some payors want line-item reporting of the codes (19318 and 19318-50) while other payors recognize the single line method as two procedures (19318-50). Be sure to bill the appropriate format to ensure you’re paid the accurate amount.