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Tissue Expander Question

  1. Default Tissue Expander Question
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    Our Doctor removed tissue expanders from the breast and then inserted implants, I think the correct code is 19342-50. I would love to hear some imput, I guess it has been a long week and I'm still not quite used to coding
    reconstructive breast procedures.
    Thanks for all help given,

  2. #2
    Thumbs up
    I would agree with that

  3. #3
    Albany, New York
    Look at 11970
    Karen Maloney, CPC
    Data Quality Specialist

  4. Default
    19342 may be reported only when documentation supports significant capsular adjustments have been performed to enable appropriate placement of the permanent implant/prosthesis. Otherwise 11970 appears to be the appropriate code.

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

  5. #5
    your right 11970 is insertion after removing expanders. 19342 is when there is a delay and the prosthesis is inserted under muscle or between muscle to accomadate. thanks

  6. #6
    I use 11970 for these procedures. After attending the ASPS meeting they indicated that this was the most appropriate code

  7. Default
    Hi Kati,
    Do you have any documentation to support the code choice of 11970 ?
    Please let me know,
    Thanks in advance for your help,

  8. Default
    The code is definitely 11970.
    Coders desk reference description for that code is: the physician removes a subcutaneous tissue expander and places a permanent prosthesis for final reconstruction...

  9. Default
    Please tell me where in the desk reference it specifically cites the breast, as I looked there as well, did you try cross coding the procedure to medically necessary diagnosis, please let me know. still looking for an actual reference that specifically states to use the code 11970 for he removal of a tissue expander from the breast and the placement of an implant.

  10. #10
    Albany, New York
    Refer to the CPT Assistant below:

    Breast reconstruction tissue expansion
    CPT Assistant, August 2005 Page: 2 Category:

    Tissue Expansion

    The most common technique of breast reconstruction involves placement of a tissue expander, an uninflated balloon-like device, beneath the skin and chest muscle. The expander, which may be temporary or permanent, can be inserted following mastectomy (immediate) or at a later date (delayed). Through a small injection port under the skin, saline is injected into the expander over a period of weeks or months, gradually filling it to the desired size while stretching the overlying skin. Code 19357, Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion, is used to report this procedure. The same code is used regardless of whether the procedure is immediate or delayed. This code is global and includes routine postoperative visits and subsequent expansions during the assigned postoperative global surgery period (eg, 90 days). When visits for expansions are necessary beyond the global period, they may be reported on a service-by-service basis.

    If a temporary tissue expander has been used, it is removed after the skin has stretched sufficiently and replaced with a permanent breast prosthesis during a second operation. This procedure is generally coded 11970, Replacement of tissue expander with permanent prosthesis. Code 11970 is global and includes removal of the temporary expander, which is not to be reported separately. In certain instances, considerable capsular adjustments are necessary to allow proper placement of the prosthesis within the fibrous capsule that has formed around the expander, and with appropriate documentation in the operative report, code 19342 is sometimes used instead of 11970.

    When a permanent tissue expander has been used, it is left in place at the conclusion of the expansion process. A second operation is not required.

    CPT Assistant © Copyright 1990-2009, American Medical Association. All rights reserved.
    Karen Maloney, CPC
    Data Quality Specialist

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