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Thread: Removal of tissue expander, breast implant, & revision

  1. #1
    Join Date
    Apr 2007
    New Port Richey & Gulf to Bay

    Question Removal of tissue expander, breast implant, & revision

    AAPC: Back to School
    My Fellow Coders,

    I have a patient who under went breast surgery involving the removal of a tissue expander with a permanent prosthesis, and revision of the SAME breast due to asymmetry. The technique used liposuction to reduce the breast to match the native. I'm a little conflicted here.

    11970 would be applied for the removing of the tissue expander and insertion of a permanent prosthesis.

    19380 would be used for the revision of the breast reconstruction. 19380 is typically used for correcting asymmetry. According to the lay description I have available, exchange of a prosthesis is included (not a tissue expander). Does the correction also include the lipsuctioning? If it doesn't, do you report a traditional liposuction CPT code?

    I had read somehwhere that 11970 would be reported by itself, because all the work to make the breast symmetrical would be included. Then going by the lay description, it seems 19380 could be the sole procedure. Then again, does that include the liposuctioning? 11970 and 19380 do not hit an NCCI edit, but despite that I feel one or the other are potentially included. Any literature corresponding on how to handle this case would be greatly appreciated. Thank you all for you assistance.

  2. #2


    I have a similar case and am pondering how to bill....

  3. #3


    Apparently there is alot of discrepancy on how to bill these. In our facility we bill both since they are not bundled by CCI edits. Most carriers (except Anthem) are paying both. We typically do not bill for the liposuction but if you want to look at it check out code 15877.

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