Why is a complete mastectomy where they remove the breast completely the same as when they do a breast biopsy? "00400" is used for both and that just seems wrong. I understand if they remove axillary nodes or muscle tissue it upgrades it, but this just seems wrong. Code "19303" for mastectomy, simple, complete crosses to "00400"...
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About this Question
- Posted by Christine Burgan 4 months ago. There are 5 posts. The latest reply is from SuperCoder.
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Will come up with an answer asap. Plz give me some time.
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ASA crosswalk here is as per ASA Guidelines.
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Both the procedures were of skin level procedures, the the anesthesia code for both is "00400" as per ASA. But, if you go for Radical mastectomy codes:
19305: Anesthesia Crosswalk is 00404 and Base Unit Value is 5.
19306: Anesthesia Crosswalk is 00406 and Base Unit Value is 13.
19307: Anesthesia Crosswalk is 00404 and Base Unit Value is 5. -
what I have trouble with is the fact that a "simple mastectomy" seems pretty invasive to me and a major surgery whereas, a biopsy is not. Yet, they are both coded the same. Just doesn't seem right, I understand that is the correct coding, but it doesn't make sense. A man must have decided that.
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You're right, Christine -- it seems strange to have such different procedures both code to 00400. But remember anesthesia codes are based on anatomic areas instead of very specific procedures like the CPT surgical codes are. Even if you're reporting 00400 for both types of mastectomy procedures, the amount of time your anesthesiologist spends on the case will be different (because, like you said, one procedure can be more extensive than another). Being able to report a higher number of time units for the more extensive procedure will help balance things out even though you'll report the same base code. I hope that helps it make sense!
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