19342 with 19316

swhitus

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I have a surgeon who wants to bill a bilateral delayed insertion (19342-50) with a RT Mastopexy (19316-RT). According to CCI these are mutually exclusive...
Here is the OP note in short form...

PreOp Dx: Hx of prev partial Lt mastectomy

PROCEDURE:
1. Bilateral augmentation of the breast for symmetry purposes following partial mastectomy.
2. Rt mastopexy for symmetry purposes following left partial mastectomy.

Procedure in Detail:
Pt brought to preop hold area....Left side addressed first. An inframammary fold incision was made approximately 2.5cm in length and carried through skin and subcutaneous tissue and the breast tissue to the border of the pectoralis major muscle which was released along the length of the inframammary fold approximately 1.5cm up from the fold. Contralateral procedure was done in a similar fashion... Symmetry was achieved with asymmetric volumes of the implants; however, additional contouring for shap and position of the nipple areolar complex was addressed with the mastopexy...The nipple areolar complex was elevated and "tacked" into position. The wedge component was then resected. Full-thickness wounds closed...

Any feedback or ideas on how to code this would be greatly appreciated..
Thanks so much!
 

Bella Cullen

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I would code this as 19340-50, 19316-RT because this is immediate insertion following mastopexy, mastectomy or in reconstruction.
19342 is for days-months after mastopexy, mastectomy or in reconstruction.
 

swhitus

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THANK YOU!!! That was exactly what I needed...the clarification on immediate vs. delayed. I really appreciate your help!
 

bnwebb

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Is 19316 included in 19342? I have a patient that had delayed placement of implant and a lift. Why would 19316 be bundled in 19342 and not in 19340? That's weird to me.
 

nyckimmie

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Hi, 19342 implant replacement bundled into 19316 mastopexy is weird to me too. I can't find coding advice that explains criteria to unbundle, these 2 different procedures. Of course contralateral is no problem, i'm talking same breast. I too am coding a bilateral delayed insertion (19342-50) with a RT Mastopexy (19316-RT). According to ncci I would be double dipping the RT side. I could do 19342 LT, 19316 RT but don't want to leave $ on the table. Does any one know the rationale of the ncci edit? thanks.
 
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