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Breast recon with latissimus dorsi flap/tissue expnader

  1. Default Breast recon with latissimus dorsi flap/tissue expnader
    Medical Coding Books
    Would anyone have a suggestion regarding this scenario?

    Breast recon with Latissimus Dorsi flap and a tissue expander placement at the same session, same side.


  2. #2
    Charleston, WV
    19361 & 19357-51 ?

  3. Default
    I persoally would bill for 19361 and 19340. I would not do 2 reconstrucation codes for the same breast.

  4. Default
    19357 includes expansions for 90 days. If you bill with 19340 you are not paid for the subsequent expansions. I use 19361 and 19357.

  5. #5
    Default 19357 and 19361
    I would bill cpt code 19361 with a 59 modifier and cpt code 19357 with 52 modifier...

    If a latissimus dorsi breast reconstruction requires the insertion of a tissue expander, the intraoperative work is not sigificantly different from that of implant insertion. The post-operative time and work, however, are greater because the patient must be seen many more times postoperatively for tissue expansion. It is appropriate to code separately for tissue expander placement, but one should use modifier -52 and append -59 modifier to the 19361 - CPT Corner...


  6. Default
    19361 and 19357-59. CPT Corner June 2009

  7. Smile latissimus dorsi myocutaneous flap with expander
    I would not use 19357 but would instead use 19361 and 19340 referenceing the CPT assistant ,March 2010 page: 9, 10 . Question:

    What are the appropriate codes to report for a breast reconstruction with latissimus dorsi flap and with tissue expander?


    For breast reconstruction with latissimus dorsi flap and with tissue expander, the correct codes are 19361 and 19340 (as the tissue expander is considered to be a breast prosthesis). It would not be appropriate to separately report code 19357, Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion.

    Previously, code 19361's descriptor included "with or without" that some read as indicating the inclusion of the insertion of an implant (when performed), rather than that the service may be done in conjunction with the use of an implant. For CPT 2007, the "with or without" was removed from the descriptor to clarify separate reporting of the additional effort to prepare and insert a prosthetic implant beneath a muscle flap for breast reconstruction. In addition, a parenthetical instruction was added following code 19361, to direct users to report code 19340 for insertion of the prosthesis, when performed in conjunction with breast reconstruction with latissimus dorsi flap, without prosthetic implant (code 19361).

    I hope this clarifies the confusion on which codes to use

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