tci Part B Insider - 2010 Issue 34

Reader Questions: Altering Coding Just to Get Paid Is a Big No-No

Question: When coding a mastectomy for gynecomastia in a male, what CPT code should I use? I would have used 19300 but the nurse says not to use that code because payers deny it for cosmetic purposes.Answer: The code for male mastectomy for gynecomastia is 19300 (Mastectomy for gynecomastia). You cannot change the coding simply because the payer considers the service to be cosmetic.Good practice: For procedures like this, it is best to check with your payers in advance to see if they have any payment guidelines related to the service. Many payers consider mastectomy for gynecomastia...

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