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removal of tissue expander

  1. #1
    Question removal of tissue expander
    Medical Coding Books
    I have a patient that had tissue expanders placed as part of her breast cancer reconstruction process. After several complications she decided to stop the reconstruction process and have the expanders removed without replacement.

    I tried to bill medicare with 11971RT and LT and then 11971-50 with payment only for one side, stating that this code is not billable as bilateral.

    Does anyone know of another code in the breast reconstruction section that would be appropriate to use in the future? I wondered about 19328 but would a tissue expander count as a mammary implant?

    I appreciate anyones input.
    The patient had a rupture, skin necrosis and finally recurrent cellulitis that made her decide to have the expanders removed. The last DX code I used was 998.32 disruption or dehiscense of surgical wound which isnt on the covered dx list for CPT 19366..... I guess with all the complications I could use 996.54 Nechanical complications due to breast prosthesis or PH of breast cancer V10.3????
    Kati Telliard, CPC, CPRC
    Last edited by Kati Achey; 10-06-2009 at 12:29 PM. Reason: added information

  2. Default
    I would use the procedure code 19366 with a complication code depending on what complication the patient had with the implanted spacers.

  3. Default
    We had this problem in the past, if you read the description of 11971 it states Removal of tissue expander (S) without insertion of prosthesis. They put that "S" on the end, so it covers one expander removal or 10 expander removals. That is what we have been told anyways. Have you tried calling Medicare?

  4. #4
    I have called Medicare and all they will tell me is what cant be billed but offer no help on suggestions.

    In looking up procedure 19366 as suggested above and as listed in Ingenix 2009 coders desk rerference Procedures....The definition is

    The physician excises skin, fat, and/or muscle from another site on the patient for use in the reconstruction of the breast following a modified readical or radical mastectomy. The tissue is excised and the operative wound is sutured in a layered repair. In preparation for the graft, any mastectomy scar is excised. The tissue is transferred to the mastectomy site. The physician adjusts the flap for the most aesthetic appearance and secures it with sutures to the chest wall, adjacent muscles and skin. An operating microscope may be employed. If the tissue does not have sufficient bulk, a breat implant may be required. The chest incision is repaired with sutures.

    I dont think this is appropriate with the original removal of tissue expander problem.

    Thanks for the input.

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