Ruptured tissue expander

jdibble

True Blue
Messages
770
Location
Daytona Beach, FL
Best answers
0
Good day all! I could use some advice - quickly!

My plastic surgeon did surgery to remove a ruptured tissue expander, performed capsulotomies on the capsule and then replaced another tissue expander. She wants to bill 19357, 19380 and 19330. I don't think these are the correct codes, but am unsure how it should be billed. I have tried to research this but have gotten even more confused. I checked the CCI edits and 19357 and 19380 would need modifier 59 if used. Below is the shortened version of the OP note for reference. I've considered 19342, 19330 & 11970 but still not comfortable with that!

...The existing left mastectomy incision was marked out, injected with local anesthesia and then sharply divided down to the implant capsule. The capsule was opened and the implant was exposed and removed. The implant was completely deflated. There was some serous fluid inside the capsule. Next, the area was pulse lavaged with 3 L of normal saline. Therewere capsulotomies performed to release the tight appearing capsule superiorly and inferiorly as well as tangential scoring anteriorly. The tissue expander with the same specifications was brought up to the field. This was prepped in the usual fashion, bathed in antibiotic irrigation. The chest was checked for hemostasis and then copiously irrigated with saline, rechecked for hemostasis and then irrigated with triple antibiotic solution. The expander was then placed within the capsule of the left breast and then a total of 200 cc was injected. This produced a minimal amount of tension on the overlying tissue. The capsule was re-closed with interrupted and then running 2-0 Vicryl sutures and then 4-0 PDS in the deep scar tissue and deep dermis and then a running subcuticular 4-0 Monocryl closure. The incision was dressed with Dermabond, and a bra was placed....

If someone could please help with this! This doctor's documentation is under internal audit here and I need to be able to explain to her the correct coding of this - and if I don't understand it I don't know how I am supposed to educate her!!

Thanks for all the help I can get!
 

Tianne

Guest
Messages
23
Location
Mansfield, OH
Best answers
0
It's been several months since I've done any plastics coding, but here is what I would do:

I would not use 19357 as this code would be used for the patient original reconstruction: revision codes would be used for any subsequent reconstruction

I also would not use 19380 as the procedure(s) performed can more accurately be described by more specific coding.

I would bill 19370 - (capsulotomy), 19330 (removal of implant material), and 19340 - I chose the immediate insertion code because this implant is being inserted immediately during the revision procedure - delayed means to me that the incision was closed and allowed a healing period for a specific reason before the implant was inserted.

Anyone else have info? I've been away from plastics for a while.....
 

jdibble

True Blue
Messages
770
Location
Daytona Beach, FL
Best answers
0
Thanks Tianne for your response. Your answer does make sense. I have brought this to my manager and another coder in my organization and they feel that I should use 19325 with a 52 modifier along with the 19330. I am not that comfortable with the 19325 as that states mammaplasty, augmentation; with prosthetic implant. I don't think this is right because of the "augmentation" portion. Your codes sound like a better choice.

If anyone else has an opinion on this I would appreciate all responses so that I can go back to this doctor with an informed response!

Thanks again Tianne.
 
Top