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Revision of breast reconstruction

  1. #1
    Default Revision of breast reconstruction
    Medical Coding Books
    Hi All~ I am new to plastics coding and I need help to make sure I am coding correctly and to explain to my surgeon why I feel this is correct coding. She did a revision reconstruction of the left breast with capsulotomy, lipectomy and immediate replacement of the implant.

    This patient had breast cancer and the revision is being done because after the first reconstruction she developed infection and later a partial capsular contracture.

    The surgeon only wants to bill 19380. After reviewing these forums it seems that she could bill 15839, 19380-51, 19370-51 and 19340-51. She thought this would be unbundling but it doesn't bundle with the CCI. Is she right about this for the 19380 code?

    Also she said that often payors don't want to pay 15839 which I told her we did not have to submit, but I think the others should be. What is everyone's opinion on this?

    Thanks in advance for your help!

  2. Arrow
    Quote Originally Posted by beck627 View Post
    Hi All~ I am new to plastics coding and I need help to make sure I am coding correctly and to explain to my surgeon why I feel this is correct coding. She did a revision reconstruction of the left breast with capsulotomy, lipectomy and immediate replacement of the implant.

    This patient had breast cancer and the revision is being done because after the first reconstruction she developed infection and later a partial capsular contracture.

    The surgeon only wants to bill 19380. After reviewing these forums it seems that she could bill 15839, 19380-51, 19370-51 and 19340-51. She thought this would be unbundling but it doesn't bundle with the CCI. Is she right about this for the 19380 code?

    Also she said that often payors don't want to pay 15839 which I told her we did not have to submit, but I think the others should be. What is everyone's opinion on this?

    Thanks in advance for your help!
    Hi,

    Per Coding Standards, she is right in saying to code 19380. If you look at the CDR of 19380 it says

    "Revision is done on a reconstructed breast, usually to correct a problem with asymmetry. The physician makes an incision in the breast skin along the areola or at the fold under the breast or in prior surgical incisions. Tissue therein may be rearranged or secured with sutures to revise the shape of the reconstructed breast. An existing breast prosthesis may be replaced with a prosthesis of a different configuration. Excess skin or tissue from the reconstructed breast may be removed. Once the breast has been revised to its desired shape, the physician repairs the incision with layered closure."

    Hence all codes you have suggested have been merged into 19380 only.

    Thank You
    Amit Joshi MSc,CPC,CPC-H

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