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Exchange of leaking tissue expander

  1. #1
    Default Exchange of leaking tissue expander
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    Hi all, I'm not too sure how this would be coded any help would be appreciated.

    Our physician is billing codes 19357 (breast reconstruction, immediate or delayed, with tissue expander)
    19380 (Revision of reconstructed breast) this code is mutually exclusive with 19357) and graft code 15330.

    It seems like there should be a code to exchange the tissue expander but I can't find one, or is the code 19357 covering all that was done, with the exception of the graft???? Below is the dictation.

    Incision was made in the right inframammary fold. Dissection was carried down from the skin to the subcutaneous tissue. Latissimus dorsi muscle was encountered inferiorly and a division was made in order to access the capsule. A capsulotomy was performed and the tissue expander was encountered. The tissue expander was removed. There was a small hole on the posterior aspect of the expander. Once the expander was removed, 360-degree capsulotomy was performed in order to increase the space of the capsule. This was carried down to the base of the expander and radial scoring was performed of the entire anterior surface of the expander. A 16 x 8 piece of AlloDerm was cut to size and placed on most of the superior aspect and medial aspect of the capsule. This was sutured to the overlying capsule using 2-0 Prolene sutures in a marionette fashion. The patient had 325 cc implant was placed into the pocket and after placement in the pocket, it was found to be too large in comparison to the left side. It was then decided to remove the silicone implant and to replace a new tissue expander to allow for further expansion of the skin and pocket. An 11.4-cm tissue expander was then placed into the pocket. Prior to this, the entire pocket was irrigated with bacitracin containing irrigation. The air was removed from the expander and the port was accessed. 150 mLof saline was placed into the expander. Marcaine was infiltrated into the pocket as well as an intercostal block. This was a 0.5% Marcaine with epinephrine. A No. 19 Jackson-Pratt drain was placed into the cavity and brought out separate stab incision prior to placement of tissue expander. The wound was then closed using 3-0 Monocryl suture followed by Steri-Strips.

    Thank you so much!!

  2. #2
    Monticello, NY
    Look at 19330 for the removal of the ruptured implant material.

  3. #3
    Default Exchange of leaking tissue expander
    I am looking at an article from CPT corner from the American Society of Plastic Surgeons June 2009.

    It states Removal of leaking expander and replacement with new expander use 19357-78

    Removal is included and not separately reportable.
    Append modifier 78 if the procedure is performed within the 90-day global period of the original procedure.

    Hope this helps!!


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