Wiki Help coding breast surgery 19342-50

Create Wiki
M

MELJNBBRB

Guru
Messages
211
Location
Austin
Best answers
0
19342-50? TIA

M,CCS,CPC




PREOPERATIVE DIAGNOSIS(ES):

1. Breast cancer.

2. Status post bilateral mastectomy.

3. Status post bilateral tissue expander and reconstruction.

4. Deflated right tissue expander.



PROCEDURE(S)/OPERATION(S) PERFORMED:

1. Bilateral replacement of tissue expanders with permanent

breast prosthesis and capsulectomy (19342.50).

2. Bilateral fat grafting (20926.50).



OPERATIVE FINDINGS:

Right breast implant, mentor reference #350-5800BC, serial

#6833512-029. Left breast implant, mentor reference #350-5800BC,

serial #6815437-038.



PROCEDURE(S)/OPERATION(S) PERFORMED:

Following induction of adequate anesthesia, the patient was

prepped and draped in the usual sterile fashion in supine

position. The right inframammary previous scar was incised.

Dissection was carried sharply down through the subcutaneous

tissue to the underlying capsule which was incised. The deflated

right tissue expander was removed. The pocket had contracted

significantly. A near complete capsulectomy was performed of the

pocket except for the posterior wall and the medial and inferior

walls. This dissection was also carried in a subpectoral ***

plane superiorly to allow for adequate redraping of the implant.

A sizer was used to determine what implant size could be

achieved. The above implant was placed after the pocket had been

copiously irrigated with dilute antibiotic solution, dilute

Betadine solution as well as having meticulous hemostasis

verified. The pocket was closed with 3-0 PDS suture and 3-0

Monocryl suture.



Similar procedure was done on the contralateral left side except

a less extensive capsulectomy had to be performed with

predominantly just the superior pole.



The patient tolerated the procedure well.
 
Here is info from CPT assistant:
from August 2005:
If a temporary tissue expander has been used, it is removed after the skin has stretched sufficiently and replaced with a permanent breast prosthesis during a second operation. This procedure is generally coded 11970, Replacement of tissue expander with permanent prosthesis. Code 11970 is global and includes removal of the temporary expander, which is not to be reported separately. In certain instances, considerable capsular adjustments are necessary to allow proper placement of the prosthesis within the fibrous capsule that has formed around the expander, and with appropriate documentation in the operative report, code 19342 is sometimes used instead of 11970. When a permanent tissue expander has been used, it is left in place at the conclusion of the expansion process. A second operation is not required.

And from January 2013:
Surgery: Integumentary System
Question:The August 2005 edition of the CPT Assistant (page 2) included the reporting of temporary tissue expander replacement, as excerpted:?If a temporary tissue expander has been used, it is removed after the skin has stretched sufficiently and is replaced with a permanent breast prosthesis during a second operation. This procedure is generally coded [with code] 11970, Replacement of tissue expander with permanent prosthesis. Code 11970 is a global service and includes removal of the temporary expander, which is not to be reported separately. In certain instances, considerable capsular adjustments are necessary to allow proper placement of the prosthesis within the fibrous capsule that has formed around the expander, and with appropriate documentation in the operative report, code 19342 is sometimes used instead of 11970.? Would the reference to the ?considerable capsular adjustments? involve capsulotomy or capsulectomy for which code 11970 may be reported in addition to code 19371, Periprosthetic capsulectomy, breast?
Answer:No. It was intended that code 11970 includes some minor adjustments to the capsule. However, when significant adjustments are made to the capsule, many of which comprise a significant part of the procedure, and when appropriately documented, code 19342, Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction, may be reported to represent the additional maneuvers that involve more surgeon time and work. For example, sometimes the capsule must be significantly modified, the infra-mammary crease must be lowered or raised, or partial or total capsulectomy must be performed.
Another example of the type of work associated with the use of code 19342 is breast reconstruction with expander in a patient undergoing postoperative expansion. When the tissue expander is replaced, it may be that the capsule is found to be very tight and multiple radial incisions may be required in the capsule to accommodate the permanent prosthesis and form a symmetric contour to the opposite breast. CPT code 11970 alone does not account for this additional work, which is over and above removal of an expander and replacement with a permanent implant.

So - reading these - 19342-50 sounds appropriate. Hope this helps.
 
You must log in or register to reply here.
Top