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Thread: help with cpt code 19380

  1. #1
    Join Date
    Apr 2007

    Default help with cpt code 19380

    AAPC: Back to School
    Hi Fellows,

    Please, I need your help about this code 19380. When do you think cpt code 19340 is appropriate to report together with 19380. I am currently using an encoder pro software and the coding tip specifies as below. I've been coding with 19380 only even tho the surgeon replaced the implant with a new one because the lay description already stated that " An existing breast prosthesis may be replaced with a prosthesis of a different configuration." Now I get confused about this coding tip. Please I need your help to make this more understandable.

    Coding Tips:
    This is a unilateral procedure. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code while others require identification of the service only once with modifier 50 appended. Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image). If an existing breast prosthesis is replaced, it may be reported separately, see 19340.

  2. #2
    Join Date
    Apr 2007
    Monmouth, NJ & Dover, DE


    Not sure if you're asking if you can code both 19340 and 19380. You can if the existing breast prosthesis is being replaced with a prosthesis of a different configuration after the recontruction/revision. Hope this helps.

  3. #3
    Join Date
    Apr 2007


    Thansks for your feedback and yes I wanted to find out if the code 19340 is billalble together with code 19380 because it seemed to me that it is not because of the lay description of the code 19380 that it also states "the existing prosthesis maybe replaced with another configuration". So I was thinking replacement is already included with this code. My idea of using 19340 with 19380 is if a patient had a breast reconstruction without any implant inserted but later on decided to have a revision then inserted an implant. We have cases like this and that is the only time I use code 19340 with 19380. Then I got confused when I read the coding tip for 19380 that 19340 may be billed (not "can be billed") if an existing prosthesis is replaced. In conclusion, what if the implant is replaced with the same type, does this mean that I cannot use 19340? But if the implant is replaced with either bigger of smaller than the previous implant then this is the time I can code with 19340? Thanks very much for your feed back. I really appreciate it. If you can perhaps give me a sample or website to read further about this. I knew DESCISION HEALTH gave a seminar about this but I was not able to attend. Could have been a lot of help for further explanations.

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