Wiki Periprosthetic capsulectomy with tissue expander exchange to implant

bostonmom

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Hi everyone,

I have been questioning what the correct way to code this type of surgery. Provider is doing a tissue expander exchange to implants and also doing a periprosthetic capsulectomy. I know the tissue expander exchange would be 11970 and the capsulectomy is 19371, but there is a CCI edit. Would it be appropriate to use modifier 59 on the 11970?

Removal left tissue expander
Left periprosthetic capsulectomy
Placement of left breast form stable cohesive gel silicone implant

Procedure began by elliptically incising the patient's prior mastectomy skin and scar as well as the wound on the patient's breast. This elliptical piece of tissue was sent for permanent pathology and the wound extent was excised. The implant capsule was then encountered and a capsulectomy was performed EN bloc with the tissue expander removed. The pocket was then copiously irrigated ensured to be hemostatic. There is no evidence of infection or fluid collections. The pocket was deemed to be appropriate for staged implant based reconstruction. Mechanical debridement proceeded further with Betadine soap sponge. A saline Sizer was then placed into the implant pocket and temporarily stapled closed. The Sizer was inflated into the appropriate size and shape was achieved without undue tension on the skin. The Sizer was then removed and the skin was re-prepped with full-strength Betadine and the pocket was prepped with half-strength Betadine and antibiotic solution. Then using no-touch technique and a breast leave funnel the implant was delivered oriented appropriately to the implant pocket. The pocket was very dry therefore no drain was placed. The pocket was then closed in layers with interrupted 2-0 PDS fascial sutures followed by 3-0 Monocryl deep dermal sutures followed by running subcuticular 4-0 Monocryl suture. The skin was cleaned and dried and skin glue was applied

Any help would be great!
 
Hi Bostonmom,
I'm attaching a September 2022 CPT Assistant. At the top of the 2nd page, it has a scenario for "If a tissue expander is being replaced with a breast implant" and it says to follow the same logic for the previous 2 scenarios for concurrent coding with 19342."
When I read the previous 2 screnarios from the Sep 2022, it's clear as mud to me. One one hand, the 11970 "includes minor revisions to the breast capsule." But then part of me says code the 19371 separately because of a CPT Assistant April 2021 passage relating to 19342 saying to code it separately (I've attached that also.)
Anyone else?
 

Attachments

  • CPT Assistant Sep 2022 19342 and 19370 and 19380 and etc..pdf
    402.3 KB · Views: 10
  • CPT Assistant April 2021 breast reconstruction.pdf
    308.1 KB · Views: 5
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