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Breast Reconstruction - necessary surgery

weshelman

Networker
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Coastal Coders
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Pt had reconstruction beginning five years ago with complications involving infection which necessitated removal of the implant on the right side which was replaced with a tissue expander. The breasts are very asymmetrical and she wants to have the left side match a little smaller and the right side a little bigger, with a permanent implant. She is a Medicare patient and I am not sure Medicare would cover the necessary surgery with a diagnosis code of 612.1 disproportion of reconstructed breast, because it states "native breast" and she has had surgery on both, although nothing but problems since. Does anyone have experience trying to bill for this type of surgery? The CPT codes would be 14020 excision of scar contracture axillary area, 15777 (because she has very thin skin on the right side) and 19342.
 
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