Insurance codes

I'm mainly an ER coder but have looked up a bunch of codes for you.  One or more of these might work.  Post mastectomy lymphedema 457.0 ; other acquired lymph 457.1  / Surgical complication NEC 997.99; Nervous system complication 997.00; other complication 997.09 / mastodynia 611.71; other specified breast disorder 611.89 / Myalgia(also fibro) 729.1; brachial or cervical plexus lesions (RIBP) 353.0 ; swelling in limb 729.81 / many codes for breast Ca 174.0 - .9. DCIS 233.0; history of breast CA V10.3, history of chemo V87.41, history of radiation V15.3  Could not find a code for dense breasts.

These are what I could think of today.  Will look up any other suggestions.

A few more :Complication of chemo 995.29; complication of implant 996.69; complication of radiation 990

lioness - Insurance companies are very slow to approve MRI's for the breasts... despite all the studies that have shown it to be a very valuable tool for younger women with dense breasts - and specifically for younger women that are breast cancer survivors. When I had my MRI of my (then) remaining breast as part of my follow ups - it took the insurance company almost 2 years to pay for it! And they even pre-authorized it. It just kept coming back as denied. First they said it was a coding error, but even with the correct coding, they were still denying. My doctor's office sent them paperwork over and over again... and I also called them several times explaining the studies and what they have shown. I asked them if they needed me to send a copy to them! Your doctor's office should be helping you, but often times the patient has to be their own advocate - unfortunate but true. Keep pushing both the doctor's office and the insurance company. You should be able to appeal their denial. When you do, send them all the documentation you can find regarding the benefits of MRI's for young breast cancer survivors. Good luck and I am sorry that you are having to go through this. 

Why don't you try to find a copy of your EOB (Explanation of Benefits) from your insurance company where they approved the other one and see what code was used for it?.  I then would show it to my doctor and ask them to be sure and use the same code.  We had to do this recently so my DP could get a medical claim covered.  If the wrong code was used it was denied but using the right code for the same claim got it covered.  In fact the rep at the insurance company also told me what code it had to be and to make sure our provider used it on their claim.  You need to make sure you get the full cooperation of your provider in this matter.  Best of luck to you!

Hi, so glad I found this thread and thanks for starting it lionessdoe, I am 3 months out of rads and have mild LE on snb arm, axilla and breast and is dreading my up coming mammo. It's almost like you read my mind and the fact that my surgery site and axilla is soooo tender that the thought of it going between that gadget clamping down is worrying me sick.

I did get an MRI of the breast prior to surgery and the report did say that there are recommending another MRI in 6 months. I don't trust my pcp, and wonder if the BS should be the one requesting my MRI? I am not sure who to go to.I have HMO.

Thanks!