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breast reconstruction w/tissue expander

Annette Posted Sun 09th of May, 2010 22:22:42 PM

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.

SuperCoder Answered Mon 10th of May, 2010 07:38:00 AM

Since, the removal of implant is bundled with CPT 19357 and to bill a 19370 (capsulotomy) you need to have diagnosis of of pain, tightness or hardness around the breast. As per the Op report it seems that the physician is only incising the capsule to insert a tissue expander. But if If the physician is performing the capsulotomy to make the new implant fit better the capsulotomy is coded in addition.
But still, I think you can only code 19357.

Any other takes guys..

SuperCoder Answered Mon 10th of May, 2010 09:40:19 AM

Please check how the service was coded back when the breast implant was placed first time. If 19357 was already coded that time, you cannot code it again this time for re-expansion because this code includes the term "including subsequent expansion".
I would rather go with 19380 for the current service.

Annette Posted Mon 10th of May, 2010 12:35:04 PM

I wouldn't know how the first time was coded.. I am billing for ASC and have no other history as what kind of surgeries the patient had in the past.. so the only thing I can do is code what's in front of me.. So that's why Im thinking maybe just 19357.
thanks to both of you!

Harish Answered Wed 19th of May, 2010 04:26:15 AM

Would code 19328 & 19357. Code 19357 does not include removal of previous implant as per code description of 19357.."The phy peformed breast reconstruction with a tissue expander, immediate or delayed. The phy makes an incision in the skin of a patient who has undergone a mastectomy. A pocket is created using an existing chest wasll muscle and an expandable implant is placed into it at the site of the mastectomy. In some cases, the implant's button-shaped portal maybe brought out through the skin so it is accessible by needle. Usually, the portal remains beneath the sufrace of the skin. The physician injects saline into the access portal to expand the implant until it has stretched the surrounding tissue to a size slightly larger than the patient's existing breast. In some cases, the expander remains a permanent prosthesis and small amount of fluid is aspirated until it duplicates the size of the existing breast. IN OTHER CASES, A SECOND SURGERY (REPORTED SEPERATELY) EXCISES THE IMPLANT AND REPLACES IT WITH A PERMANENT BREAST PROSTHESIS."

Annette Posted Wed 26th of May, 2010 15:06:47 PM

okay.... thank you.

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