okay.. so I am billing for ASC but surgeon's ofc wants to bill cpt's 19328 & 19357. I think it should be 19370 & 19357 or maybe just 19357? removal of implant is bundled with 19357. what do you guys think? thanks
A skin marking pens was used to outline the area also preoperatively of left breast scar depression to be revised. The area of left breast scar was then anesthetize to the use of injection of 1% xylocaine with epinephrine and local anesthetic solution and then appropriate waiting period was observed to aid in adequate hemostasis. The excision of the depressed area, the scar was carried out as outlined and through the use of electrocautery was extended down through the pectoralis major muscle to the breast implant. The implant was then removed and was found to be a Megan round, textured, slaine filled implant with a 495cc marking on it. The capsule was then incised circumferentially at its lateral aspect and also incsied on its anterior aspect to allow for expansion. The pocket was measured and was felt that it would accommodate the tissue expander, which was planned, which was 800cc. The tissue expander was removed from the box, checked for leaks none were found. The air inside and tissue expander was removed. The tissue expander was placed in the left breast pocket region and fradually inserted and that was placed after initial extension of incision to allow for the implant. The tissue expander deep placed. The incision had been extended to the use of electrocautery and sharp dissection. The implant was put into position and greadually infalted to approximately 350cc. At which point the muscular tissues were repaired using interrupted sutures of 3-0 sutures of 3-0 vicryl. The expansion was then continued percutaneously to total of 600cc. incision was further closed with running subcuticular intradermal suture. the implant was further inflated, the tissue expander was then further inflated to 650cc of sterile saline.