November 5, 2015

Question:

Since the new diagnosis codes for absence of the breast includes one specifically for bilateral, will modifier 50 (bilateral procedure) still be required on the CPT code? For example, for bilateral breast reconstruction with a tissue expander and biologic implant, we will use Z90.13 for acquired absence of bilateral breasts and nipples for the diagnosis code. Will we still need modifier 50 on the CPT codes 19357 and 15777?

Answer:

YES! Nothing changes with CPT coding with the implementation of the new diagnosis coding system, ICD-10-CM. So in your example, you’d use 19357-50 and 15777-50 (or 19357, 19357-50, 15777, 15777-50 if the payer prefers each code be listed separately). Click here to see our newly released webinar for everything you ever wanted to know about ICD-10-CM Coding for Plastic Surgery!

*This response is based on the best information available as of 11/05/15.