Wiki Is it a 19380 (revision reconstructed breast)?

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jdrueppel

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Is this a 19380 (revision reconstructed breast) or not?? Any Plastics experts please help.

I'm billing anesthesia for this service. Both the surgeon and facility billed this as a 19380 but I'm having a hard time coding to that level, instead, I was looking more at the repair codes, however, there is a 2 anesthesia base unit reduction for the repair codes versus the breast revision code. If this is a 19380, what in the dictation are my key words/points that would support CPT code 19380?

Postop dx: status post bilateral mastectomy and immediate reconstruction with limited necrosis along the mastectomy incision bilaterally

Surgery: Revision of mastectomy incisions bilaterally
Indication: Patient several weeks s/p mastectomy and reconstruction with progressive necrosis along the mastectomy incisions

Findings and Procedure:
Pt was placed in supine, prepped and draped in sterile fashion, following successful general endotracheal anesthesia with the arms extended on arm boards. Using a marking pen then, the area of demarcation was highlighted with the pen, and a #10 blade scalpel was then used to incise along this line of demarcation and then followed up by using a curved Metzenbaum's to excise the nonviable tissue and debride it from the incision line and fresh up the skin edges. We then noted that the graft was essentially non-integrated at this point, and it was healthy and showing no signs of distress, so we proceeded to close the incision using a series of inverted interrupted 2-0 undyed Vicryl on a CT-1 needle followed by running subcuticular 3-0 Monocryl and an ES-2 needle. The left breast incision was handled in a similar fashion with the the non-viable, non-healthy looking skin and subcutaneous tissue removed, excised, and mostly from the inferior breast flap and then approximating the edges again using a 2-0 Vicryl in the deep dermal layer followed by running subcuticular 3-0 Monocryl for the skin. Dressings consisting of Xeroform, 4x4s, and limited amount of paper tape.

Thanks for any and all help.
Julie D, CPC
 
Julie - I asked a similar question (see my post from 9/23/10 entitled "Please help with correct codes") The response I received advised this would be a debridement, not a revision as the 19380 is for when the breast needs to be corrected for shape or size, etc.

From reading your note, it looks like the same procedure that was performed in my posted note - so I would say that this was coded incorrectly as a revision and should be coded from the repair codes such as a debridement.

Hope this helps - if someone has a different take on this I would like to hear it as I have to code for both the Plastic Surgeon and now the Anesthesiologist too! :eek:
 
I agree that it does sound like debridment, putting in consideration 10180, 11042,11043,complex closures.....

I've came to the conclusion and from experience as a Plastic coder, 19380 is better off then those listed above with bundling issues/CCI edits and the most revenue for the work rendered.

19380 is a really broad code that encompasses many type of revisions and procedure on a reconstructed breast. Just because this was a Mastectomy case as well, and it is basically revising the incision, 19380 is okay to use

EncoderPro discription of 19380

Revision is done on a reconstructed breast, usually to correct a problem with asymmetry. The physician makes an incision in the breast skin along the areola or at the fold under the breast or in prior surgical incisions. Tissue therein may be rearranged or secured with sutures to revise the shape of the reconstructed breast. An existing breast prosthesis may be replaced with a prosthesis of a different configuration. Excess skin or tissue from the reconstructed breast may be removed. Once the breast has been revised to its desired shape, the physician repairs the incision with layered closure.
 
msid123 said:
I agree that it does sound like debridment, putting in consideration 10180, 11042,11043,complex closures.....

I've came to the conclusion and from experience as a Plastic coder, 19380 is better off then those listed above with bundling issues/CCI edits and the most revenue for the work rendered.

19380 is a really broad code that encompasses many type of revisions and procedure on a reconstructed breast. Just because this was a Mastectomy case as well, and it is basically revising the incision, 19380 is okay to use

EncoderPro discription of 19380

Revision is done on a reconstructed breast, usually to correct a problem with asymmetry. The physician makes an incision in the breast skin along the areola or at the fold under the breast or in prior surgical incisions. Tissue therein may be rearranged or secured with sutures to revise the shape of the reconstructed breast. An existing breast prosthesis may be replaced with a prosthesis of a different configuration. Excess skin or tissue from the reconstructed breast may be removed. Once the breast has been revised to its desired shape, the physician repairs the incision with layered closure.
Click to expand...

Thank you msid123 for your repsonse. I do have a question about this:

So what you are saying is that according to the EncoderPro description you can use 19380 when the surgeon takes the patient back to the OR to remove necrotic skin, etc. and this would include the layered closure. If the surgeon is stating that the closure is complex, would you code this separately or is this included in the procedure?

My plastic surgeon documents all of her procedures stating the closure is complex and wants me to code the closure separately. I am trying to determine when the complex closure is included and when it would be appropriate to code this separately (aside from lesion removals where it clearly states you would code this separately.

I would greatly appreciate any help in this as I seem to be going in circles with my surgeon as to what can and should be billed.

Thanks,
 
There is a CCI edit when trying to code any repair with any of these breast codes in general. It is all bundled within the code it self. The only way to send it out to insurance companies is to but a modifier 59, which will be an invalid usage that is considered fraud/unbundling.

Lesion removals are a different story, only reporting closure when intermediate and complex only. excision from the muscular skeletal section/ more radical resections does not allow for an extra repair either, even though the instructions in the CPT, and Encoder Pro says it is allowable...It is a new NCCi edit and will not get paid, especially by Medicare.

MS
 
Can the 19380 be used if there are no implants placed or anything of that nature? It says "reconstructed" in the title.

Our patient has "the puckering on the lateral part of the scar which is a problem and needs to be revised. A dog ear that went in and not out."

Redundancy and dimpling of right mastectomy with subcutaneous fluid.

"Her right mastectomy site was prepped and draped in sterile fashion. An elliptical skin incision was made to remove the dimpling area that was hard to clean and also cosmetically unappealing. This was not a cosmetic surgery, though this had dimpling that was so severe that even at surgery, I could not get that area to come out, so then an elliptical skin incision was made around that area taking symmetrical skin that let us down to the pocket, where we were able to place a #15-Blake drain bringing out through a separate stab incision. I fixed the skin with 3-0 nylon and then I sewed the skin back together with running 3-0 Vicryl interrupted nylon sutures and staples in between to get this to lay nice and flat. She tolerated the procedure well. She was taken to the recovery room in good condition."

This was originally coded as a 15839. Does anyone have other suggestions?
 
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