Rupture/Reconstruction

KoBee

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Anyone else having trouble distinguishing CPT 19330 and 19380 as to when they can be separately reportable. Noticed 19380 is bundled into 19330 but when do you actually unbundle this code combination?
 

cpc2007

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The edit between 19330 and 19380 has a rationale of "Mutually Exclusive Procedures." This means that the two procedures cannot reasonably be performed at the same anatomic site during the same encounter. Given that rationale and the description/guidelines of what is included in each code, I would not report 19380 and 19330 together in the same surgery unless the work described by these codes occurs in opposite breasts (e.g., right breast with reconstruction after mastectomy that is revised and left breast cosmetic implant that is ruptured and needs to be removed). It would be pretty rare to see both in the same surgery in my experience.

Not 100% sure what scenario you are trying to report, but if your goal is to report revision to the capsule/soft tissues and removal with replacement with a new implant in a reconstructed breast, I would consider 19380 and 19342 together (removal of old implant material would be included in 19342).

I hope that helps :)

Kim
www.codingmastery.com
 

KoBee

Guru
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220
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The edit between 19330 and 19380 has a rationale of "Mutually Exclusive Procedures." This means that the two procedures cannot reasonably be performed at the same anatomic site during the same encounter. Given that rationale and the description/guidelines of what is included in each code, I would not report 19380 and 19330 together in the same surgery unless the work described by these codes occurs in opposite breasts (e.g., right breast with reconstruction after mastectomy that is revised and left breast cosmetic implant that is ruptured and needs to be removed). It would be pretty rare to see both in the same surgery in my experience.

Not 100% sure what scenario you are trying to report, but if your goal is to report revision to the capsule/soft tissues and removal with replacement with a new implant in a reconstructed breast, I would consider 19380 and 19342 together (removal of old implant material would be included in 19342).

I hope that helps :)

Kim
www.codingmastery.com
Thank you so much :)
 
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