General Surgery Coding Alert
Update Your Breast Reconstruction/Repair Coding Know-How
Drill down to significant code revisions. With 15 revised codes and two code deletions, pl.us a new introduction and 24 new text notes, you have a lot to learn from the CPT® 2021 Breast Repair and/or Reconstruction section (19316-19396). Our experts are here to help you understand how the code changes might impact your procedure reporting in 2021. Check Out the Code Revisions, Deletions You’ll find the following code changes in CPT® 2021 (strike through deleted, underline added) You’ll notice that several changes to these codes involve removing the word “prosthesis” in favor of “implant.” Some of the codes also remove the word “mammoplasty,” leaving just the specific descriptors such as “breast augmentation” or “breast reduction.” In those cases that involve simply updating the definition to more medically appropriate language, the substance of the codes do not change, according to Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico. Deconstruct Significant Mammoplasty and Implant Changes Although updated language won’t alter how you use the codes, other changes are more significant and could impact how you code. For instance, the old description for 19340, specifically included immediate prosthesis insertion after not just a mastectomy, but also after mastopexy and/or reconstruction, notes Karen Pickering, RHIT, CCS, founder of ReviewMate and Senior Consultant for Pinnacle Enterprise Risk Consulting Services LLC. In contrast, you should now use the code only for implant insertion “on the same day of mastectomy,” based on the code revision. Parallel revisions appear in the code 19342 definition that help distinguish it from 19340, specifying that the procedure is “on a separate day from mastectomy.” Similar to 19340, the 19342 revision also removes “following mastopexy … or in reconstruction.” Finally, revised code 19342 includes “replacement” of breast implant, not just initial insertion. While 19328 describes removal of intact breast implant, you can readily distinguish the code from revised code 19330, which now includes the language “ruptured breast implant.” The 19330 code update also removes the word “material” in favor of clarifying that the procedure includes removing “implant contents (eg, saline, silicone gel).” Tissue expander: CPT® 2021 simplifies code 19357 to “Tissue expander placement in breast reconstruction, including subsequent expansion(s).” The old description stated “breast reconstruction, immediate or delayed, with tissue expander,” and many coders found this definition confusing, because it seemed as if the breast reconstruction was included, Pickering says. The revision makes it clear that you should use 19357 in addition to the appropriate breast reconstruction code when the surgeon inserts a tissue expander. Recall that you have two codes in the CPT® Integumentary Introduction section for removing the tissue expander or replacing it with a permanent breast implant. CPT® 2021 also updates these codes as follows, to update the word “prosthesis” to “implant,” and to clarify that the code involves one tissue expander: Augmentation: CPT® 2021 deletes code 19324, but adds a text note stating, “To report breast augmentation with fat grafting, see 15771, +15772.” These codes describe autologous fat grafting to various sites, including breasts, as follows: Tighten Breast Reconstruction Understanding As you can see from the code-revision list shown earlier in this article, CPT® 2021 revises breast reconstruction codes 19361-19380. Some of the changes are minor language updates similar to what we’ve previously discussed, such as changing 19370 and 19371 to reference “peri-implant” instead of “peri-prosthetic.” Other language updates include changing “double pedicle” to “bipedicle” in 19369. Change parent code: CPT® 2021 makes 19361 the parent code to all breast reconstruction codes through 19369. Each code in the range begins as “Breast reconstruction;” and the descriptor that follows distinguishes the codes using the phrase “with … [technique description].” The technique descriptions include the following: You’ll notice that CPT® deletes the “other technique” code, 19366, from this breast reconstruction code family. Instead, the 2021 code revisions expand examples within the code descriptors so that you can choose the most specific code rather than reaching for the unspecified code. These details include providing examples of free flap in 19364: … (eg, fTRAM, DIEP, SIEA, GAP flap). Confusion: The phrase “without prosthetic implant” in 19361 had confused some coders that they could not report the code for a procedure that involved an implant. By removing that phrase from 19361 and adding text notes, CPT® 2021 clarifies that if the latissimus dorsi flap procedure involves an implant, you should separately code that work. Revision codes: CPT® 2021 updates 19370-19380 by adding detail that clarifies what work each breast revision code describes, as follows: Guidelines: In addition to the code changes explained in this article, CPT® 2021 adds a long introduction and many text notes to the Breast Repair and/or Reconstruction section that are beyond the scope of this article. Look to future issues of General Surgery Coding Alert to learn how those additions can further clarify your use of these codes.
mammaplasty)19324 (Mammaplasty, augmentation; without prosthetic implant) deleted codeMammaplasty, augmentation Breast augmentation with implant; with prosthetic implant)mammary breast implant)mammary ruptured breast implant material, including implant contents (eg, saline, silicone gel))Immediate Insertion of breast implant prosthesis following mastopexy, mastectomy or in reconstruction on same day of mastectomy (ie, immediate)Delayed Insertion or replacement of breast “ implant on separate day from mastectomy)Breast reconstruction, immediate or delayed, with tissue expander Tissue expander placement in breast reconstruction, including subsequent expansion(s)), without prosthetic implant)19366 (Breast reconstruction with other technique) deleted code(TRAM), single pedicle, including closure of donor site)Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor site)Open periprosthetic Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, breast and/or partial capsulectomy)prosthetic-implant capsulectomy, breast, complete, including removal of all intracapsular contents)
prosthesis implant)(s) without insertion of prosthesis implant).
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