Cases , Coding

Mark Gittleman, MD/

Dr. Gittleman's Coding Corner: Skin or Nipple Sparing Mastectomy

Question: Performing a skin or nipple sparing mastectomy is more difficult, requires more skill, and takes more time than does a traditional mastectomy for cancer. Is there a code other than CPT 19303 (mastectomy, simple or complete) that I can use?

Answer: Unfortunately, there is no code that reflects the additional work of a skin, or nipple sparing mastectomy. The only possible tactic is to use the -22 modifier (increased procedural service) appended to 19303. There has been reportedly mixed success utilizing this approach. There has always been a concern that an application for a request for a new code for these extended procedures, would result in the re-evaluation of 19303 reimbursement and would probably result in an overall decrease reimbursement for the mastectomy codes.

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