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Wiki capsulectomy

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Amy Brazell

Networker
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Irmo, SC
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How do you code removal of tissue expander with replacement by permanant prosthesis if a capsulectomy is also done. From the CPT Asst. it looks like 19342 but I'd like some input. Thanks.
 
I would do 11970 for the replacement of tissue expander w/ permanent prosthesis, and then 19371 for capsulectomy. There is no CCI edit. Not sure why cpt assist would choose 19342.
 
there's a website from the American Society of Plastic Surgeons that completely breaks down all of those codes, and they have a CPT corner in every issue of their magazine. You should see if your physician subscribes to that magazine.

According to the archived files, it says that that when a tissue expander is removed and replaced w/ a permanent prosthesis, report 11970 if no other procedures are performed. This code includes exposure, incision of the capsule to access the expander, removal of the expander and the injection port, and placement of a permanent prosthesis. Coding for separately for any of these components is unbundling.

Good luck!
 
Thank you for your response Sundae.

I have been coding these scenarios using only CPT 11970, but wanted something documented in case I am questioned.

Thanks Again!

Karen Maloney, CPC
Data Quality Specialist
 
Sundaey, we have got the CPT corner in the past I highley recommend it. I just started doing the surgery coding for our office and am going to see if we can subscribe to it again.
 
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