Question 19342 & 19371

D.R.

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Can 19342 & 19371 be billed together when performed on the same breast?

Procedure(s):
Bilateral exchange of breast implants and right breast capsulectomy

Indications: This is a 67 yo female s/p prior bilateral skin sparing mastectomy with saline implant reconstruction. She has been followed in my office since her reconstructive surgeon had moved her practice. She presented recently with a left implant rupture. Additionally, she had a right breast capsular contracture that had been noted on her first visit. We discussed proceeding with bilateral exchange of breast implants and any revisions as needed. After discussion of the risks and benefits of this procedure, she is ready to proceed.

Procedure: The patient was brought to the operating room and placed on the table in the supine position. Preoperative antibiotics were given and bilateral sequential compression devices were placed on her legs. Following a briefing, the patient was placed under general anesthesia after which her chest was prepped and draped in usual sterile fashion. Following timeout identification, inframammary fold markings were made and injected with local anesthesia. The right breast was addressed first. The marking was incised and dissection was carried down to the capsule which was noted to be calcified. Dissection proceeded around the capsule as far as safely possible anteriorly with the implant in place. The inferior aspect of the capsule was then entered into and the textured implant was removed. An anterior capsulectomy was then performed due to the calcification, The posterior capsule was adherent to the chest wall and overall soft so this was left undisturbed. The excised capsule was sent to pathology for evaluation. Following hemostasis and irrigation, a sizer was placed temporarily in the pocket. The left side was then addressed. The inframammary fold marking was incised and dissection was carried to the capsule which was incised to allow removal of the ruptured textured implant. Due to the capsule being soft, adherent and of good quality, this was not removed on the left. A sizer was placed in the left as well and the patient was evaluated in both the supine and sitting positions. Based on this evaluation, further lateral capsulotomies were performed bilaterally for better positioning of the implants and the final implant size was chosen. Following hemostasis, antibiotic and betadine irrigation was performed. After this was complete, the final implants were placed via a Keller funnel. On the left, this was a 350 cc Mentor MemoryGel Breast Implant Smooth Round High Profile ref# 350-3504BC, SN# 9556193-063. On the right, this was a 350 cc Mentor MemoryGel Breast Implant Smooth Round High Profile ref# 350-3504BC, SN# 9556193-029. After placement, the incisions were closed using interrupted 2-0 Vicryl suture for the subcutaneous layer, interrupted 3-0 Monocryl suture for the dermal layer and a running 4-0 Monocryl subcuticular closure. After closure, the chest was cleaned, dried and Xeroform and dry dressings were applied. The patient was then brought out of anesthesia without difficulty and transferred to the recovery room in stable condition. All counts were correct at the end of the case and I was present for the entirety of the procedure.

TIA
 

fwnewbie

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Contractures are pretty common and included in the work of a revision and may only take a bit of blunt dissection. The capsulectomy (biopsy) could qualify as medical necessity if the original mastectomies were due to a cancer diagnosis so you might have to dig a bit to come up with that information to include with the claim.
 
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D.R.

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Thank you so much. For some reason I really struggle with breast procedures. I have a hard time finding resources that will answer my questions relating to the plastics/reconstruction portion of these surgeries, post mastectomy. Maybe I am searching in the wrong places but the info I find is very basic and not very detailed. It's basically the info I can find in the NCCI Edits table.
Thanks again!!
 

such78

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CPT 19371 is for a complete capsulectomy and includes the removal of all intracapsular contents. It cannot be assigned with 19328 and 19370, but 19342 can be reported separately for replacement of a new implant.
 
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