tci General Surgery Coding Alert - 2008 Issue 11

Reader Questions: Biopsy Can Be Separate From Mastectomy

Question: If the surgeon performs a breast biopsy, and if frozen section comes back positive, also performs a mastectomy, can you bill for both procedures? If so, will I need modifiers? Virginia Subscriber Answer: You can report both the biopsy and mastectomy,as long as the results of the biopsy prompted the mastectomy (for instance, if biopsy shows malignancy). Many biopsy codes are bundled with lumpectomy and mastectomy codes in the national Correct Coding Initiative (CCI). But this does not mean they cannot be billed together: The CCI edits do not apply when the biopsy is diagnostic (that is...

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