CPT/Modifiers
19370 Modifiers 78,50,XU
19328 Modifiers 78,50,XU
19342 Modifiers 78,50
Dx: C50.111
Patient was brought into the room and placed in the supine position. General anesthesia was administered. The patient’s chest was prepped and draped in a sterile fashion. An incision on the right side was made through the lower incision of the latissimus flap. On the left side was made through the mastectomy scar. Dissection was carried down through the soft tissue and muscle to the breast capsule. The capsule was incised. The tissue expander was deflated and removed intact. An extensive capsulotomy was then performed around the base of the implant pocket and then up radial to the incision. Sizers were placed and was determined that a 550 cc style 45 high profile implant was to be used on the right and a 539 cc ultra high implant was to be used on the left. The pockets were irrigated with saline solution there was good hemostasis. The pockets were then instilled with a Betadine-saline mixture. My gloves were changed, and has only 1 to handle the implant. A Keller funnel was used to place both the implants. The implants were placed without difficulty. The breast capsule, muscle, and soft tissue were reapproximated over the implant using 3-0 Monocryl suture. The skin was closed using 3-0 Monocryl deep dermal sutures and 4-0 Monocryl running subcuticular. I did have to take a little extra skin out on the right side to tighten up over the implant to try to match the size of the left side. Patient tolerated the procedure well and was transferred to recovery room in stable condition

I’ve tried a number of modifier combinations & Medicare has rejected all.
Thank you for any insight