Wiki Periprosthetic Capsulectomy, breast

[butterflyjane]

Can anyone help with clarification? My plastic surgeon wants to bill a 19371 - periprosthetic capsulectomy, breast and also 19328 - removal of intact mammary implant and 19330 - removal of mammary implant material. He is removing the entire implant, but not reinserting a new one. I think that I can bill the 19371 with 19330 because he is removing the entire implant. Is this correct or would both 19328 and 19330 be bundled with the 19371 or can I bill either one with a modifier?

 

[Mconway03]

according to CCI 19371 is not bundled with 19328 or 19330. 19371 is a unilateral code so if the doctor performed a capsulectomy on both sides then use the modifier 50 on 19371.

 

[magnolia1]

CPT 19371 includes removal of the implant.
Therefore, it would not be appropriate to code 19328 or 19330 in addition
to 19371 unless you are coding the situation noted in the CPT Assistant below:

Integumentary System

Question

In a case when the breast implant has ruptured and the implant material extends beyond the capsule, markedly infiltrating surrounding tissue, should I report the removal of implant material in addition to the capsulectomy?

AMA Comment

It would be appropriate to report both the capsulectomy code 19371, Periprosthetic capsulectomy, breast, and the removal of implant material using code 19330, Removal of mammary implant material, given the above circumstances. Otherwise, the capsulectomy code 19371 includes the removal of the old implant material.

 

[mkmgt001]

Hi Karen (or anyone), Do you have a resource that supports that the removal of an implant (19328) is inclusive in the capsulectomy (CPT 19371)?? This denial absolutely makes SENSE to me, but CCI doesn't support the denial.

Thanks much!
Mary Kittredge, CPC

 

[CVR]

The American Society of Plastic Surgeons states that "the removal of the implant comes with the capsule-the capsulectomy can't be performed without removing the implant, therefore it is incidental"

 

[mkmgt001]

Thank you CVR! It seems crazy to me that CCI allows this code combination (CPT 19371 & 19328). It would be nice if they were onboard with AMA & American Society of Plastic Surgeons.