Wiki Removal of ruptured implants

[susanruss]

We are having trouble getting paid for ruptured implant removal. How are other offices coding for these? It seems that they are wanting to pay only the removal of material 19330, no other codes such as capsulectomies or implant removal. We are doing most of the surgeries in our surgery center. Thanks

 

[dkissel]

While I don't think there is a NCCI edit, most payers see the implant removal as inclusive to the capsulectomy or capsulotomy now. If there is a capsule, we just bill for that.

 

[such78]

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.