Medicare Compliance & Reimbursement - 2014 Issue 7
Reader Question: Consider Global and Bilateral for Code Selection
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Article Overview
This article addresses a breast surgery coding scenario involving a postoperative return to the operating room and comparison of procedure reporting options for the original breast case and the opposite breast case. It is relevant to coders working with surgical global periods, bilateral procedure reporting, and breast lesion excision versus partial mastectomy/lumpectomy coding. The discussion also touches on laterality reporting and modifier selection in the context of a reader question.
Why This Topic Matters
Understanding how to distinguish related postoperative breast procedures from separate breast lesion excisions affects accurate claim reporting and consistent use of global surgery and bilateral procedure modifiers. The article helps coders evaluate which general type of breast surgery code family applies and what broad modifier categories may be considered.
Article Sections
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Question
Introduces the coding scenario involving breast surgery on both sides and asks about possible procedure coding and laterality reporting options.
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Answer
Explains the general coding approach for the scenario and discusses postoperative timing, bilateral reporting, and laterality modifier considerations.
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Modifiers
Summarizes the laterality and bilateral modifier discussion in relation to the procedures described.
What You Will Learn
- How a postoperative breast re-excision and a contralateral breast procedure may be discussed in coding guidance
- How global surgery concepts can affect a breast surgery claim
- How bilateral and laterality reporting is addressed in a reader question format
- How to think about broad breast procedure categories when reviewing coding advice
Who Should Read This
- Professional coders
- Outpatient surgery coders
- Billing staff
- Coding educators
- Auditing professionals
Codes Discussed
Modifiers Discussed
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