Tissue Expanders in Breast

alaweber

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Indianapolis, IN
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Can someone help with this? Doc is using 19357 x 3 - which is breast reconstruction. Can only use quantity of 1 or modifier 50…which this isn’t bilateral. I am getting hung up on the verbiage…in Encoder under the description is states physician makes an incision in the skin of a patient who has undergone a mastectomy.

There are tissue expander insertion codes but they are not for breasts. Am I getting too focused on the words? Should I just use 19357 with a quantity of 1?

PREOPERATIVE DIAGNOSIS: Large congenital nevus, right breast.

POSTOPERATIVE DIAGNOSIS: Large congenital nevus, right breast.

PROCEDURE PERFORMED: Insertion of breast tissue expanders x3.

ATTENDING PHYSICIAN:

RESIDENT PHYSICIAN:

ESTIMATED BLOOD LOSS: Minimal.

SPECIMENS: None.

DRAINS: Externalized tissue expander port.

COMPLICATIONS: None.

INDICATIONS FOR PROCEDURE: The patient is a pleasant 17-year-old with a
history of large congenital nevus of the right breast. This had been
removed in a sequential fashion and she required additional skin in order
to have a more normal appearing breast. Risks, benefits, and alternatives
of tissue expander placement were described with the risks described as
bleeding, infection, damage to surrounding structures, need for further
surgery, scarring, and asymmetry. She understood the risks and provided
written and verbal consent and requested the procedure.

DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient
was transported to the operating room where general anesthesia was induced.
Preoperative antibiotics were given, and all bony prominences were padded.
She was prepped and draped in a standard sterile fashion after a time-out
was performed for the patient and procedure identification.

Incisions that was made on her right breast had the inferolateral incision
and inferomedially. A 15 x 600 mL tissue expander was placed into her
superomedial pole and in her lateral pole. A 225 rectangular 10 x 6 cm
tissue expander was placed. A similar 225 mL 10 x 6 tissue expander was
placed inferiorly as well below the inframammary fold, taking care to
preserve the inframammary fold. All ports were externalized through a
separate incision within the congenital nevus on the breast. They were all
closed with 4-0 PDS in an interrupted deep and subcuticular fashion
respectively and a running subcuticular Prolene was placed. 60 mL of
saline was placed in the inferior and lateral tissue expanders and 50 was
placed in the superior medial one. The patient tolerated the procedure
well, was extubated and transferred to the PACU.


END OF REPORT
 

victoriamoll

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Fleetwood, PA
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That's a new one to me, I've never seen multiple expanders in one breast. The 19357 is the correct code. Even though it wasn't a complete mastectomy, the patient did have breast tissue removed, which would technically be at least a partial mastectomy. CMS has an MUE of 1 on the 19357, so I think even with 3 expanders you should still only bill 1.
 
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