# Exchange of expander devices for implants



## smcbroom (May 24, 2010)

I need my fellow coders help on this one.  The consulting company wants to code this as 19380 RT,LT but I am thinking 19342 RT,LT???  Also, I know in the description for 19380 it states an existing prosthesis is replaced with a prosthesis of a different configuration so I think that's what is throwing me off and the fact it was the expander devices that ruptured not the typical breast implants.  Here is the op report:

PREOPERATIVE DIAGNOSIS:
1.	Bilateral mastectomies for cancer of the breast, status post staged-reconstructive procedure with the use of expander implants.

POSTOPERATIVE DIAGNOSIS:
1.	Bilateral mastectomies for cancer of the breast, status post staged-reconstructive procedure with the use of expander implants.

OPERATION PERFORMED:
1.	Exchange of expander devices for implants bilaterally.


DESCRIPTION OF PROCEDURE:  Under satisfactory general anesthesia, the patient was prepped and draped with ChloraPrep in the usual manner.  Midportion of the old transverse scars was opened, opening an incision about 1.5 inches to 2 inches in length.  The expander devices were delivered.  They had ruptured and were removed from both sides.  New devices consisting of smooth saline moderate-profile permanent breast implants were inserted, manufactured by Mentor.  On the right side, we used an 800-mL implant.  On the left side, we used a 700-mL implant, filled to 800 mL and 700 mL respectively.  On the left side, the reference was #350-1697 and serial #5981412-045.  On the right side, the reference was #350-2800 and serial #5987903-024.  As mentioned, 800 mL of fluid were added to the right side and 700 mL on the left side, which was delivered to make up some disproportion volume to give symmetry.  After final positioning of the implants, the wounds were closed in layers with interrupted 3-0 Vicryl in the deeper tissue and running subcuticular 4-0 Vicryl in the skin.  Blood loss was estimated at 50 mL.  The patient tolerated the anesthetic and procedure well and left the operating area in good condition.  Sponge and needle counts were correct.

We have started doing breast procedures more often and wanted some help with this.

Thanks!
Susan, CPC-H


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## Kevinph84 (May 25, 2010)

If the provider is exchanging tissue expanders with a permanent prosthesis, I would use CPT code 11970 (Replacement of tissue expander with permanent prosthesis). This code represents unilateral service.


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