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Revision of recons. breat, tissue exp remove, insertion of new implants

Joe Posted Fri 27th of May, 2011 16:22:26 PM


The surgeon goes into the op room and does a 19380 (Revision of Reconstructed breast) and then does a capsulectomy using 19371 x2, 50 on one, and reports 11970 (Replacement of Tissue Expander w/permanent prosthesis) x2, 50 on one - for the insertion of the breast prosthesis. There are no NCCI edits found between these codes. I have a problem with 19371 because the procedure say removal of breast implant. Does this look right to anyone?

SuperCoder Answered Fri 27th of May, 2011 16:59:36 PM

As the code 19371 is appropriate for periprosthetic capsulectomy, breast, you could code this and it includes removal of a breast implant.
It does not include, however, reinsertion of that breast implant or a new breast implant. When a capsulectomy is performed, the prosthesis is not always replaced. Additional physician work is necessary to revise the area and reinsert a prosthesis. Moreover, the implant is often placed in a different plane, requiring further dissection of a new pocket. When performing a periprosthetic capsulectomy with removal of implant and reinsertion of breast implant, report CPT codes 19371 and 19340.

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