Replacement of tissue expander with permanent prosthesis

KBean2018

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Hello, Would I code as 11970-50 or 19342? What would I code for the implants-15777? or are they included in code? thank you

Pre-op Diagnosis:
history of left breast cancer, acquired absence bilateral breasts

Postop Diagnosis:
same
*
Procedure:
Bilateral - REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS
*
Implant:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used
800ML BREAST IMPLANT Breast Implants *
800ML BREAST IMPLNT Breast Implants
*
*
Condition: stable
*
Indications for Surgery:s/p bilateral mastectomies with tissues expander reconstruction 3/23 for left breast cancer. *She completed her expansion at 750 cc and is happy with her size.*Plan for second stage breast reconstruction with removal of tissue expanders and placement of permanent round silicone implants.**Risks of infection, scarring, asymmetry, wound healing issues, hematoma, seroma, contracture and implant loss discussed and consent obtained.
*
Procedure: in the preoperative holding area and appropriately marked. She was then brought back to the operating room and placed supine on the operating room table. SCDs were placed on bilateral lower extremities. Her arms were outstretched on padded foam arm rests and abducted to less than 90 degrees at the shoulder. . She underwent general anesthesia. A pec 1/2 block with exparel was performed. She was prepped and draped in the usual sterile fashion. Attention was first turned to the left breast.. *I entered through the old medial IMF*mastectomy incision. I then raised the mastectomy skin off from the implant capsule approximately 1 cm superiorly and inferiorly. I then made a capsulotomy. The tissue expander was intentionally ruptured and removed.* Under direct visualization with a lighted breast retractor *capsulotomies were performed superiorly and medially. The capsule was also scored anteriorly. *The lateral IMF was recreated with several figure of 8 2-0 maxon sutures after scoring the lateral breast capsule. This was done to move the footprint of the pocket 1-2 cm medially. An 800 smooth round gel sizer was placed which filled the skin envelope. *Antibiotic irrigation was used to irrigated the cavity which consisted of 500 cc NS and 1 gram ancef, 80 milligrams gentamycin, and 50,000 units of bacitracin. Electrocautery was used for hemostasis. *Following this I changed my gloves and a smooth round high profile gel 800 cc implant was placed. The capsule and skin were then closed with interuppted 3-0 polysorb sutures. Then a running 4-0 biosyn subcuticular suture was used. *
*
Attention was then returned to the right side. *The same procedure was performed. *Less capsule release was performed, and no capsulorraphy laterally was needed. Dermabond prineo was placed over the incisions. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
 
Last edited:
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2
Best answers
0
Hello, Would I code as 11970-50 or 19342? What would I code for the implants-15777? or are they included in code? thank you

Pre-op Diagnosis:
history of left breast cancer, acquired absence bilateral breasts

Postop Diagnosis:
same
*
Procedure:
Bilateral - REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS
*
Implant:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used
800ML BREAST IMPLANT Breast Implants *
800ML BREAST IMPLNT Breast Implants
*
*
Condition: stable
*
Indications for Surgery:s/p bilateral mastectomies with tissues expander reconstruction 3/23 for left breast cancer. *She completed her expansion at 750 cc and is happy with her size.*Plan for second stage breast reconstruction with removal of tissue expanders and placement of permanent round silicone implants.**Risks of infection, scarring, asymmetry, wound healing issues, hematoma, seroma, contracture and implant loss discussed and consent obtained.
*
Procedure: in the preoperative holding area and appropriately marked. She was then brought back to the operating room and placed supine on the operating room table. SCDs were placed on bilateral lower extremities. Her arms were outstretched on padded foam arm rests and abducted to less than 90 degrees at the shoulder. . She underwent general anesthesia. A pec 1/2 block with exparel was performed. She was prepped and draped in the usual sterile fashion. Attention was first turned to the left breast.. *I entered through the old medial IMF*mastectomy incision. I then raised the mastectomy skin off from the implant capsule approximately 1 cm superiorly and inferiorly. I then made a capsulotomy. The tissue expander was intentionally ruptured and removed.* Under direct visualization with a lighted breast retractor *capsulotomies were performed superiorly and medially. The capsule was also scored anteriorly. *The lateral IMF was recreated with several figure of 8 2-0 maxon sutures after scoring the lateral breast capsule. This was done to move the footprint of the pocket 1-2 cm medially. An 800 smooth round gel sizer was placed which filled the skin envelope. *Antibiotic irrigation was used to irrigated the cavity which consisted of 500 cc NS and 1 gram ancef, 80 milligrams gentamycin, and 50,000 units of bacitracin. Electrocautery was used for hemostasis. *Following this I changed my gloves and a smooth round high profile gel 800 cc implant was placed. The capsule and skin were then closed with interuppted 3-0 polysorb sutures. Then a running 4-0 biosyn subcuticular suture was used. *
*
Attention was then returned to the right side. *The same procedure was performed. *Less capsule release was performed, and no capsulorraphy laterally was needed. Dermabond prineo was placed over the incisions. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
19342-50 is applicable in this case. He performed enough reconstructive work to justify a breast reconstruction with implants rather than a simple removal and replacement of TE with permanent prosthetics. If this was performed in the office, you would code the implants L8600x2 but, if at a facility, the facility provides the implants and should bill for them.
 
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