Placement of Acellular Dermal Matrix in Breast Reconstruction

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October 30, 2014

Question:

I did a bilateral tissue expander reconstruction with placement of acellular dermal matrix in the soft tissue for reinforcement. I coded this as 19357-50 and 15777-50 but my biller told me I could not bill 15777 with modifier 50. She said 15777 should only be billed once. Is this true?

Answer:

No, it isn’t true. The CPT guidelines directly underneath 15777 in the manual say: For bilateral breast procedure, report 15777 with modifier 50. Therefore, 15777 may indeed be reported with modifier 50.

Medicare and many payors did not set up their systems to acknowledge 15777 as accepting modifier 50 when the code was introduced in 2012. But after the first 3-6 months most of the payors, including Medicare, were on board and recognize modifier 50 when appended to 15777.

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