Sorry to beat a dead horse but I need help...

CPT Assistant Aug 2005 states regarding breast reconstruction - if a surgeon is removing tissue expanders and replacing them with permanent implants, 11970 is to be used. It also states "In certain instances, considerable capsular adjustments are necessary to allow proper placement of the prosthesis within the fibrous capsule that has formed around the expander, and with the appropriate documentation in the operative report, code 19342 is sometimes used instead of 11970."

Here is my problem - does the op note below indicate 'considerable capsular adjustment'?

"....Attention was directed to the right breast where a 6 cm incision was made overlying the previous scar. A 2 cm half moon was created inferiorly just above the capsule, thus creating an inferior capsular flap. Bovie electrocautery was used to transverse through the capsule exposing the tissue expander. The tissue expander was punctured using the scalpel and the sterile methylene blue saline was drained. An Allis clamp was used to gently remove the tissue expander after ensuring all of the sutures were excised. Examination of the pocket displayed a well formed capsule with no signs of infection or abnormalities. Bovie electrocautery was used to do a capsulotomy of the superior and medial portions of the breast pocket. The left breast had a similar surgical procedure performed as outlined above to the right breast. ........." And then it goes into irrigating and placing the implants.

Any thoughts would be greatly appreciated regarding the 'capsulotomy of the superior and medial portions of the breast pocket' ....considerable capsular adjustment or not?