Forum - Questions & Answers

Sep 17th, 2015 - vickiwoods

attempted breast reconstruction

My surgeon has presented me with a surgical scenario that has me stumped. Please give me some direction as I have never seen this before:

My surgeon had planned to immediately insert an breast prosthesis after the 1st surgeon completed a mastectomy. My surgeon inserted the prosthesis, covered it with Alloderm, suturing the Alloderm to the pectoralis muscle. He then checked with the SPY machine, no blood flow. He removed the implant. He checked with the SPY machine again-still no blood flow. He had the OR warmed and put warm lap pads over the area. He performed a breast reduction on the contralateral breast and then checked the flaps for the first breast again. Still no blood flow. He closed the breast, electing not to proceed with the implant.

How do I code this? Thank you for any direction you can give me.

Sep 17th, 2015 - petunia 195 

re: attempted breast reconstruction

Have you considered the 53 modifier with the procedure code for reconstruction?

53 modifier is for discontinued procedure

Under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. Note: This modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).

Sep 17th, 2015 -

re: attempted breast reconstruction

for the insertion of the implant i would use the code that you normaly use when he does a breast implant,(19325) possbily and add a modifier 53 and also a modifier to state which side the implant was being performed on to show that is was a discontinued service. as for the the breast reduction code 19318 sounds like that would be the correct code and I would add the modifier that identifys which side the reduction was done on. The modifiers would be the LT or RT. We may also need to add modifier 59 to the 19318 to show that is was distinct procedural service. this is how is should look when billing out the services;

19325 LT/RT 53
19318 LT/RT 59

Sep 17th, 2015 - petunia 195 

re: attempted breast reconstruction

I wish we could like comments... :)

Sep 17th, 2015 -

re: attempted breast reconstruction

Thank you so much for the responses. I had considered modifier 53 but felt like the procedure had been done and then undone. However, final closure had not been accomplished for the implant so I'm thinking your idea is correct and I will bill it that way.



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