Tanya Posted Mon 18th of July, 2016 11:50:57 AM
Medicare denied payment for a Breast Bilateral Advancement Flap. We sent the codes as followed.
14000-50-XS-GA (this was denied for payment).
Is this supposed to be covered?
SuperCoder Answered Tue 19th of July, 2016 03:15:07 AM
According to the limited information available, the codes given for breast bilateral advancement flap seem to be appropriate if the procedure is preceded by the removal of partial portion of the breast. These are payable codes. Please specify the reason for denial of these codes provided by the Medicare. Also, the modifier 50 is not applicable for the code 14000, so do not report it with the code.
Tanya Posted Mon 07th of November, 2016 10:00:34 AM
Sorry, for not getting back to you. Medicare states "The Procedure code is inconsistent with modifier used or a required modifier is missing.
SuperCoder Answered Tue 08th of November, 2016 08:42:36 AM
As described earlier, the modifier 50 is not applicable for CPT code 14000, so do not report it with the code. You can reapply the procedure with no 50 modifier with it. This will not deny the procedure.