Question Breast Recon

D.R.

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Please help!! I don't why I get so confused w/ plastics & breast px's. I feel the more I look into it the more confused I get. Should I use 19380 for right breast or 11970? This is what I have now
19318 - LT
19380 -RT
13101 - 59
36590
15771 - RT
15772 x3 - RT
Thanks!!
PREOPERATIVE DIAGNOSIS:
1. History of breast cancer.
2. Breast asymmetry following breast reconstruction
POSTOPERATIVE DIAGNOSIS: Same.
NAME OF PROCEDURE:
1. Right breast tissue expander exchange for permanent implant
2. Right breast superior and lateral capsulotomy
3. Right breast fat grafting: 170 cc
4. Left breast reduction for symmetry.
5. Removal of left chest port.
6. Left chest port site scar revision: 3 cm
INDICATIONS: This is a 34-year-old female who presents for right breast . Risks include bleeding, infection, damage to surrounding structures, nipple sensation change, partial dehiscence, scarring, pain, possible need for revision surgery. She expressed understanding the risks and agreed to undergo the aforementioned procedure and informed consent was obtained.
DESCRIPTION OF PROCEDURE: The patient was identified and marked in the Preoperative Holding Area. She was then brought to the Operating Room, where a briefing was performed during which time the patient, procedure, site of procedure and appropriate documentation were confirmed by the entire Operating Room staff. She underwent induction of general anesthesia with LMA placement. Bilateral breasts and abdomen were prepped and draped in the usual sterile fashion. A timeout was then performed during which time again the patient, procedure, site of procedure and appropriate documentation were confirmed by the entire operating staff.
A right breast IMF incision was made 5.5 cm in length. The tissue expander was drained and removed. Superior and lateral capsulotomies were performed with barrel staving of the capsule edges for shaping of the implant pocket. Sizers were used to determine the optimal implant and 755 high profile XTRA mentor implants were selected and placed with a keller funnel. The inferior capsule was approximated with interrupted 2-0 vicryl. The dermis with buried interrupted 3-0 monocryl. The epidermis with running subcuticular 4-0 monocryl.
Next, the left upper chest port scar was excised over 3 cm in length due to scar widening. Dissection to the implanted port was performed with electrocautery. The port was freed and removed. Pressure was held over the left clavicle and internal jugular access site for 15 minutes to ensure hemostasis. The subcutaneous catheter tract was closed with figure of 8 3-0 PDS. The subcutaneous tissue was approximated with buried interrupted 3-0 vicryl. The dermis was approximated with buried interrupted 3-0 monocryl. The epidermis with running subcuticular 4-0 monocryl.
A left breast superior medial pedicle breast reduction was designed and the nipple areola complex was marked with a 45 mm cookie cutter. The pedicle was de epithelialized and excess inferior and lateral breast skin and soft tissue was excised. The skin was temporarily stapled and placed in a sitting position to evaluate breast symmetry. The breast parychema was approximated with interrupted 2-0 vicryl. The dermis was approximated with buried interrupted 3-0 monocryl. The epidermis was approximated with running subcuticular 4-0 monocryl. The incisions were covered with dermabond and steri strips.
Bilateral abdomen and flanks were infiltrated with tumescent solution through bilateral abdominal stab incisions and an evo body jet water assisted liposuction machine was used to harvest fat grafting material. Small stab incisions were made with an 11 blade scalpel and coleman fat grafting canulas were used for placement of fat graft material. 170 cc of fat graft material was infiltrated into the right breast and chest for contouring. Stab incisions were approximated with buried interrupted 4-0 monocryl in the dermis and interrupted 5-0 plain gut in the epidermis. All incisions were covered with dermabond and steri strips.
 

nickelclaw

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Peru, IN
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11970-RT exhange of expander with implant
19370 might need a modifier(XU) for the RT capsulotomy per the CPT guidance this may be billed if revision is required for implant, extensive capular revision, partial capsulectomy. In this case the documentation supports this.

19380 is revision of reconstruction of breast. Think of it as when an expander is placed you know that the reconstruction is incomplete. Where the revision code would be example implant was done but they come back for other reasons.
Hope this helps!
 
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