# Tissue Expander Question



## bella2 (Oct 30, 2009)

Our Doctor removed tissue expanders from the breast and then inserted implants, I think the correct code is 19342-50. I would love to hear some imput, I guess it has been a long week and I'm still not quite used to coding
reconstructive breast procedures.
Thanks for all help given,
Bella


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## ASC CODER (Oct 30, 2009)

I would agree with that


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## magnolia1 (Oct 30, 2009)

Look at 11970


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## ciphermed (Oct 30, 2009)

19342 may be reported only when documentation supports significant capsular adjustments have been performed to enable appropriate placement of the permanent implant/prosthesis. Otherwise 11970 appears to be the appropriate code.

Hope this helps,


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## ASC CODER (Oct 30, 2009)

your right 11970 is insertion after removing expanders. 19342 is when there is a delay and the prosthesis is inserted under muscle or between muscle to accomadate. thanks


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## Kati Haughton (Oct 30, 2009)

I use 11970 for these procedures. After attending the ASPS meeting they indicated that this was the most appropriate code


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## bella2 (Nov 4, 2009)

Hi Kati,
Do you have any documentation to support the code choice of 11970 ?
Please let me know,
Thanks in advance for your help,
Bella


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## Bella Cullen (Nov 10, 2009)

The code is definitely 11970.
Coders desk reference description for that code is: the physician removes a subcutaneous tissue expander and places a permanent prosthesis for final reconstruction...


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## bella2 (Nov 10, 2009)

Please tell me where in the desk reference it specifically cites the breast, as I looked there as well, did you try cross coding the procedure to medically necessary diagnosis, please let me know. still looking for an actual reference that specifically states to use the code 11970 for he removal of a tissue expander from the breast and the placement of an implant.


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## magnolia1 (Nov 10, 2009)

Refer to the CPT Assistant below:


Breast reconstruction tissue expansion
CPT Assistant, August 2005 Page: 2 Category:  

Tissue Expansion 

The most common technique of breast reconstruction involves placement of a tissue expander, an uninflated balloon-like device, beneath the skin and chest muscle. The expander, which may be temporary or permanent, can be inserted following mastectomy (immediate) or at a later date (delayed). Through a small injection port under the skin, saline is injected into the expander over a period of weeks or months, gradually filling it to the desired size while stretching the overlying skin. Code 19357, Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion, is used to report this procedure. The same code is used regardless of whether the procedure is immediate or delayed. This code is global and includes routine postoperative visits and subsequent expansions during the assigned postoperative global surgery period (eg, 90 days). When visits for expansions are necessary beyond the global period, they may be reported on a service-by-service basis. 

If a temporary tissue expander has been used, it is removed after the skin has stretched sufficiently and replaced with a permanent breast prosthesis during a second operation. This procedure is generally coded 11970, Replacement of tissue expander with permanent prosthesis. Code 11970 is global and includes removal of the temporary expander, which is not to be reported separately. 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 appropriate documentation in the operative report, code 19342 is sometimes used instead of 11970. 

When a permanent tissue expander has been used, it is left in place at the conclusion of the expansion process. A second operation is not required. 

CPT Assistant © Copyright 1990-2009, American Medical Association. All rights reserved.


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## bella2 (Nov 10, 2009)

Thanks Karen , that's exactly what I needed


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## aam720@gmail.com (Mar 23, 2011)

Hello Karen,

I saw your response to this previous post so I wanted to get your feedback...but here is the situation...it's a little different.

The patient had previously undergone bilateral mastectomy and immediate bilateral tissue expander AlloDerm reconstruction.  Patient developed complications (within the global period) from the left tissue expander (left breast drain infection) and was readmitted, where the left chest tissue expander was removed and replaced.  

This situation is different in that the permanent prosthesis has not yet been inserted.

The original breast reconstruction code of 19357 was used, and now we need to code the procedure to remove and replace the left chest tissue expander without prosthesis.  The following codes are not appropriate: 11960 (other than breast), 11970 (with prosthesis), 19330 (tissue expander is not implant material), and 19380 (not a revision of a reconstructed breast).  

Do you think the phrase 'including subsequent expansion' in 19357 would refer to any time a tissue expander is removed and/or replaced, regardless of the reason, i.e., infection, leakage, defective, more expansion is needed, etc., and therefore would be nothing further to code?  There is code 11971, but that is just for the removal of the tissue expander...does not code for the replacement.

Please advise; your help is much appreciated!


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## magnolia1 (Mar 23, 2011)

Hello......

Your choice is 19357 (because code descriptor says "Breast Reconstruction,immediate or *delayed*, with tissue expander")

I would not code the removal of the original expander separately....you have to take the old one out to put the new one in.

Hope this helps..........


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## aam720@gmail.com (Mar 24, 2011)

Thanks for the quick response, Karen!

So just to confirm...the original reconstruction was billed with code 19357 and the subsequent procedure to remove and replace the tissue expander due to infection would also be billed with code 19357 with modifier 78 (unplanned return to OR during the global period, etc.), right?


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## magnolia1 (Mar 24, 2011)

I think you may want to use Modiifer "76" or "77" instead........


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## kbazarte@yahoo.com (Mar 28, 2011)

What are the codes for INSERTION of tissue expander?

Is there a HCPCS code?


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## msgoodwin (May 5, 2011)

Is there a cpt code for filling a tissue expander that was placed by a different surgeon?


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## FTessaBartels (May 6, 2011)

*Are you taking over post op care?*



msgoodwin said:


> Is there a cpt code for filling a tissue expander that was placed by a different surgeon?



Assuming the different surgeon is NOT in your same practice ...

Are you taking over post-op care?  If so, you should be coding the procedure with a -55 modifier (and the surgeon who placed the expander should use a -54 modifier).

Hope that helps.

F Tessa Bartels, CPC, CEMC


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