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Thread: Need help coding this surgery

  1. #1
    Join Date
    Apr 2007
    Chicopee, MA

    Default Need help coding this surgery

    AAPC: Back to School
    I have a breast cancer patient who underwent bilateral mastectomy and stage 1 of her breast reconstruction 19357 (brst recon, immediate or delayed w/ tissue expander).

    The patient returned to the operating room preop diag: spontaneous rupture of expander, infection of RT brst reconstruction site & partial extrusion of expander.

    The surgery performed was removal of the expander, debridement of infected tissue w/ removal of the preplaced alloderm & granulation tissue along with the placement of a wound V.A.C.

    The patient was admitted for observation where she received IV antibiotics.

    The CPT codes provided to me by the surgeon was 11971 (removal of tissue expander w/out insertion of prosthesis) & 97606 (negative pressure wound therapy)

    It is my opinion that 11971 does not accurately describe the entire procedure performed. This case appears to be unique and I can’t find a CPT code (or codes) that accurately describe the entire surgery.

    Would you suggest submitting 11971 with mod 22 (unusual procedural services)? Or 19499 (unlisted procedure of the breast) w/ proper documentation? Or is there another code (or codes) that would more accurately describe the procedures done?

    I have never coded a surgery like this, please help…

  2. #2


    It was recommended by the Life Cell reimbursement specialist to bill this utilizing the unlisted breast code CPT 19499 with a comparison to removal of prosthetic material or mesh, abdominal wall for infection CPT 11008 for pricing and work value.
    Thank you

  3. #3
    Join Date
    Apr 2007


    Report 19380 and alloderm 15330


  4. #4
    Join Date
    Apr 2007
    Daytona Beach, FL


    Quote Originally Posted by msid123 View Post
    Report 19380 and alloderm 15330

    15330 would not be billed for a removal - that code is for the application.

    It would be better if the entire note was posted to come up with what code would be better...

    Possibly could use 19380, 11971 & 97605 or 97606 depending on the size of the wound. Again, there could be other codes - it would depend on how the procedure was documented. If you could post the note that would help.
    Jodi Dibble, CPC

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