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Thread: Denials for proc 19342 & 19370

  1. #1
    Join Date
    Apr 2007

    Post Denials for proc 19342 & 19370

    AAPC: Back to School
    I am new in coding plastics, but I am being denied by insurance companies for using 19342 & 19370. I do not see where it is bundling, but the denial states surgical package or exceeds allowance for service. Can anyone give me and hints on how this should be billed.

    pt post 1st stage reconstruction rt & lt side, hx breast ca
    procedure done:
    rt & lt removal of tissue expander with placement of permanent breast prosthesis
    rt & lt capsulotomy and revision of reconstructed breast

    This is what the dr coded- 19342 Rt & LT
    19370 RT & LT
    Last edited by Arlene; 10-16-2008 at 09:44 AM. Reason: example of surgery

  2. #2


    Can you give us an example situation?

  3. #3
    Join Date
    Apr 2007


    please see the edit example

  4. #4


    According to the CPT corner June 2006

    11970 Replacement of tissue expander with permanent prosthesis
    19370-51 Capsulotomy

    or because some payers over bundle 19730 into 11970.

    11970 Replacement of tissue expander with permanent prosthesis
    19370-59 Capsulotomy


    19342 only becuase some payer will not acknowledge taht these are clinical situations where reporting these two codes is correct

    Hope this helps

  5. #5
    Join Date
    Apr 2007
    Albany, New York


    Please see below some info provided by another coder back in September.

    I think you should only be using 11970 (x2).

    Karen Maloney, CPC
    Data Quality Specialist

    there's a website from the American Society of Plastic Surgeons that completely breaks down all of those codes, and they have a CPT corner in every issue of their magazine. You should see if your physician subscribes to that magazine.

    According to the archived files, it says that that when a tissue expander is removed and replaced w/ a permanent prosthesis, report 11970 if no other procedures are performed. This code includes exposure, incision of the capsule to access the expander, removal of the expander and the injection port, and placement of a permanent prosthesis. Coding for separately for any of these components is unbundling.

    Good luck!
    Malama pono,

    Sundae, CPC

  6. #6
    Join Date
    Apr 2007


    Thanks To All- This Helps

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