Gynecomastia

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February 20, 2014

Question:

Our staff were having difficulty obtaining precertification for a male patient with gynecomastia. When I submitted my surgical codes for the day, I gave the staff CPT code 19300 Mastectomy for Gynecomastia. My staff said I could not report this code, but had to report 19301 for a partial mastectomy. I am not in agreement with this, but am new to coding my own cases. Can you provide guidance?

Answer:

You are correct to reach out, and this is great timing. The ACS is sponsoring a Comprehensive Breast Coding Seminar in February in Orlando. Topics such as this will be discussed. The answer is “no”, you cannot report 19301 because the payor would not pre-certify. Other business activities must occur to ensure proper payment—choosing a code “just to get paid” is not acceptable. In your case, report 19300 since this is the procedure performed. There may be nothing you can do at this time to have the claim paid, but KZA can help assist you in the future.