This gets a little deep and depending on the Dx and the entire Op note it could go several different directions.
19328 is the removal of intact mammary implant. No replacement or insertion of prosthesis is included in this code. This code is only to be used for removal of intact gel or saline implant or ruptured saline shell. If removal AND replacement at the same time - use 11970 to replace an expander or 19340 to replace an implant (19342, if capsulotomy required to free space to place the implant) This is usually done for cosmetic/symmetry purposes.
19342 Delayed insertion of breast prosthesis following mastopexy, masetectomy or in reconstruction. Delayed means performed at a later date than the mastectomy procedure. This can be used for removal and replacement of ruptured saline implant with capsular modification or replacement of expander where moderate capsular work is required. This is not for use on the non-cancer breast requiring symmetry (use 19325). Some other instances where 19342 would be appropriate would implant exchange, expander removal w/implant insertion. Never bill 19342 w/11970.
You are correct with the 19380. This is a revision of reconstructed breast (bra roll reduction).
11970 is to be used if tissue expander is replaced with permanent prosthesis this includes capsulotomy (19370) and you cannot report separately. Medicare does not recognize code as bilateral so use modifier 59 to indicate second side, if performed.
11971 is used when tissue expander(s) are removed without insertion of prosthesis. This is a unilateral code, Medicare does not recognize code as bilateral so use modifier 59 to indicate second side, if performed. Some carriers may prefer modifier 50 if done bilateral - check with your specific carrier.
Without know full details on the Op note I don't feel comfortable giving you a specific code but from what you've included in your post 19328 would be inappropriate. I think you need to look at 11970 & 11971. I hope this information helps you.
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join