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cpt code 19380

  1. #1
    Default cpt code 19380
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    Hi All,

    I just need to find out if this code 19380 (revision of reconstructed breast) is also applicable to those patient who had a cosmetic breast augmentation before. How would you code when a patient that was status post breast augmentation and needed a revision? Thanks for your input.

  2. Default
    I would say yes. But the claim will probably be denied by commercial payors due to the diagnosis and/or medical records.
    Anytime I have a patient who has previously had a breast reconstruction for any reason and are coming back for implant exchange or are having problems and require the implant to be removed and either replaced with the same or new one I will use the 19380 and the 19340 if a new implant is placed. The 19380 covers the rearrangement, suturing or even removal of tissue within the capsule. Our docs are always going back in after a breast reconstruction and state they are doing a capsulotomy or capsulectomy and replacing the implant with one of a different configuration. 19380 and 19340 covers all of that.

  3. #3
    Default
    Per CPT Assistant:

    Breast reconstruction is a surgical procedure designed to recreate a breast mound following

    a mastectomy performed to treat cancer or other disease, or a mastectomy performed for prophylactic purposes. Reconstruction can be accomplished by using a prosthesis (implant) or the patient's own (autogenous) tissue, such as a flap of muscle with or without overlying skin, that is moved from its native site and transferred to the breast area recipient site. In some cases, a combination of both may be used. The reconstructed breast is sized and contoured to match, as closely as possible, the remaining breast. Occasionally the remaining breast may also require surgical contouring (coded separately).

    I'd say a revision of a reconstruction is related to what is described above.

    Is the surgeon just replacing breast prostheses?

  4. #4
    Default
    yes, MD will replace a new implant with a different configuration. I know 19380 is revision of reconstructed breast its just the this scenario is a post breast augmenation. Breast implant will be replaced with a larger one + capusulectomy. CPT 19371 includes removal and 19340 can be reinsertion but MD also do some capsulorrhapy and also rearrangement of tissue due to disproportion/assymetry problem. It seemed like 19380 fits its just that the way it is written as revision of reconstructed breast. Thank you for your help.

  5. Default 11970 vs 19380
    What if the surgeon is removing the tissue expander (post mastectomy due to cancer) and putting in a permanent implant? No rearrangement of tissue is documented. 11970 or 19380?

    Quote Originally Posted by coderguy1939 View Post
    Per CPT Assistant:

    Breast reconstruction is a surgical procedure designed to recreate a breast mound following

    a mastectomy performed to treat cancer or other disease, or a mastectomy performed for prophylactic purposes. Reconstruction can be accomplished by using a prosthesis (implant) or the patient's own (autogenous) tissue, such as a flap of muscle with or without overlying skin, that is moved from its native site and transferred to the breast area recipient site. In some cases, a combination of both may be used. The reconstructed breast is sized and contoured to match, as closely as possible, the remaining breast. Occasionally the remaining breast may also require surgical contouring (coded separately).

    I'd say a revision of a reconstruction is related to what is described above.

    Is the surgeon just replacing breast prostheses?

  6. #6
    Default
    Cpt 11970

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