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#1
03-11-2011, 09:58 AM
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Breast Reconstruction with Capsulectomy
My provider often performs a capsulectomy (19371) before doing a breast revision (19380). Empire Blue Cross specifically will not pay for the 19371 because they state it is included in the 19380. However, I cannot find any documentation that either confirms or denies this, any thoughts?
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#2
03-18-2011, 10:01 AM
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our office performs these procedures as well. there isn't a CCI edit when billing both codes together, but we bill one or the other. since there is a definitive code for a capsulectomy, i would go with 19371 - i.e. capsulectomy w/removal of implant/expander, ruptured implant w/in the capsule, etc. i'd also bill 19340 if another implant is replaced. we bill 19380 for removal of tissue/skin, capsulorraphy, or adjustments made in breast pocket.
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#3
05-08-2012, 04:41 PM
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Capsulotomies with removed of tissue expanders and placement of implants
If the physician performs extensive capsulotomies, removes tissues expanders replacing them with implants, and performs axillary liposuction -- 19370, 19342, 11970, 15877.
Does 19380 include the capsulotomies? The way I read 19380 is that the physician is performing revision of breast where implants have already been placed. It talks about tissue rearranged and the existing prosthesis being replaced by a prosthesis of a different configuration. Any help would be appreciated. Last edited by JBowyer; 05-09-2012 at 08:59 AM.
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#4
05-09-2012, 08:57 AM
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If the physician performs extensive capsulotomies, removes tissues expanders replacing them with implants, and performs axillary liposuction -- 19370, 19342, 11970, 15877.
Does 19380 include the capsulotomies? The way I read 19380 is that the physician is performing revision of breast where implants have already been placed. It talks about tissue rearranged and the existing prosthesis being replaced by a prosthesis of a different configuration. Any help would be appreciated. __________________ JBowyer
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