Wiki Can CPT 19380 be billed in an office setting?

[andreanpadgett]

Our provider is wanting to perform a breast reconstruction procedure (revise breast for symmetry--crescent-shaped skin and breast excision inferolaterally) under local in our office. He is wanting to use CPT 19380, but I noticed that this code is rarely performed in a non-facility setting. Can this be performed and billed in the office setting and approved by a BCBS plan or should this be performed in a facility setting since considered rarely performed in a non-facility setting? Any help is appreciated as this is the first case like this I have encountered.

 

[SharonCollachi]

19380 is revision of a reconstructed breast, not just a reconstruction or revision (although that may be what you meant). When I get questions from my boss (the doctor), that start with, "hey, can I do this in the office?", my first reaction is to check our malpractice policy. Are we covered for this type of procedure in the office setting, or would it be more appropriate in an ASC or hospital, with the corresponding licensed professionals who will be monitoring vitals, checking IVs, etc. My next question is, what can go wrong?

The answers to those two questions usually resolve the issue.

It sounds like in your case, you know what the answer should be. Why risk it?