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Breast reconstruction guidance needed

louise Posted Thu 13th of February, 2020 06:36:25 AM
Bilateral reconstructed breast revision with excision of left breast fat necrosis. 19380 Bilateral lateral chest wall standing cone deformity excisions with intermediate complexity closure (23 cm). Neo-umbilical creation with adjacent tissue transfer (2 x 1 cm) and full- thickness skin grafting from the right lateral chest wall (4 x 1 cm). 17999 Lower abdominal scar revision with intermediate complexity closure (4 cm). 13101
SuperCoder Answered Fri 14th of February, 2020 05:42:34 AM

Hi Louise,

CPT code 19380 is appropriate to bill for revision of reconstructed breast. In this procedure, the physician removes excess amounts of tissues, skin, and fats to reshape the breast to look like the contralateral (other) breast. If necessary, a new prosthesis can also be used. For bilateral side, use modifier 50 with 19380. Repair of the surrounding area will be part of breast reconstruction, so need not the bill separately.

For neo-umbilical creation, CPT 17999 can be used, and since adjacent tissue transfer (ATT) has been performed then use the CPT 14000 (Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less) for ATT procedure.

For lower abdominal scar revision, if it the part of neo-umbilical creation procedure, then it will not be billed separately, if it is not the part, then code 13101 for complex repair of trunk (size 2.6 cm to 7.5 cm), else if it is intermediate repair then use CPT 12032 (size 2.6 cm to 7.5 cm). Check the op-report to distinguish between the complex and intermediate repair.

Also, when billing CPT 19380 and 13102 together, code 13101 is a column 2 code for 19380, but you may use a CCI-associated modifier to override the edit under appropriate circumstances.

Hope this helps!

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