Sort of new....Need diagnostic code.

Hi, I'm sorta new, but not really.  I had my RNY on June 29, 2010 and currently post under another another name, but due to stalker issues from a board off the OH I've created a new profile to discuss plastics.  I just don't want to hear the taunts from this stalker duo on AOL really. 

O.K. that out of the way.  I have a diagnostic code question.  I am looking at a breast reduction, because although I've lost 105lbs I'm still a 34DD+.  I cannot find bras that remotely fit.  Either I have to get cups that are too big and simply don't support anything or I'm spilling out the sides and middle of the bra.  All I'm interested in is a reduction, because I've got plenty of mass, just no density to it any longer and it's affecting my neck and back now.

So what diagnostic code should I be asking for to have the best chance for Medicare to approve just a reduction?

Thanks.

. :)

Hi, the code for suspension of breast is 19316.

Thanks. :)

Medicare will not approve 19316 as it's a mastopexy (breast lift) code and is considered cosmetic. Breast reduction is 19318. If you have "deflationary" changes as you describe, that would not be a breast reduction in the traditional sense as it's loose skin without bulk in many MWL patients.

Medicare is difficult to deal with for breast reduction surgery. They do not do preauthorization. After not getting paid a few times on Medicare breast reductions after the fact, most surgeons eventually do not perform this service on MC benificiaries.