Oncology & Hematology Coding Alert

Find out if a broken implant qualifies as a foreign body.

The 2022 updates to the CPT^® surgery guidelines contain a small addition that could lead to some large confusion for oncology coding.

This update does two things. First, it provides new definitions that differentiate between an implant and a foreign body. Then, it tells you how to apply these changes to coding broken implant removals under the new rules.

Does this mean that your broken breast implant removal code choices will change on Jan. 1, 2022? Want to get all this straight before the guideline takes effect? Here’s what you need to know.

Understand When an Implant Is Not an Implant

The new guideline begins with instructions that helps you understand that an implant, whether “diagnostic or therapeutic” is “an object intentionally placed by a physician or other qualified health care professional for any purpose.”

In contrast, CPT^® 2022 tells you that “an object that is unintentionally placed (eg, trauma or ingestion) is considered a foreign body.”

Find Out Why This Is Important

The new guideline then explains the significance of this distinction, stating that “if an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes.”

In other words, if your provider removes a ruptured silicone breast implant, or a saline implant with a leaking valve, CPT^® 2022 seems to instruct you to code the procedure as a foreign body removal and not an implant removal.

However, the final part of the new guideline stipulates that you will only apply this definition to your removal code choice “unless CPT^® coding instructions direct otherwise or a specific CPT^® code exists to describe the removal of that broken/ moved implant.” And you will need to bear this part of the guideline addition in mind before changing the way you code implant removals.

Know What This Means

For intact breast implant removals, the guideline will not impact your coding in 2022. You will continue to follow guidelines accompanying the breast repair and/ or reconstruction section of the integumentary system surgery codes, which tells you that “removal of an intact breast implant without replacement is reported with 19328 (Removal of intact breast implant).”

But the guideline’s definition of a structurally broken implant being a foreign body does not mean you should now be reaching for 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated) for a ruptured or leaking implant in 2022. You will still use the tried-and-true 19330 (Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel) for a simple removal of a broken or leaking saline or silicone gel implant.

Why? Remember, the guideline comes with the caveat that you should code a broken implant removal as a foreign body removal “unless … a specific CPT^® code exists to describe the removal of that broken/moved implant” [emphasis added]. As 19330 very clearly describes the removal of a ruptured breast implant and its contents, this is the code you should continue to use to document these encounters into 2022 and beyond.

Here’s How This Will Affect Your Coding

“This could impact surgeries where implantable ports malfunction, move or otherwise need to be replaced. But you’ll need to document the reason for the removal or replacement to verify which code should be used,” advises Kelly Loya, CPC-I, CHC, CPhT, CRMA, Associate Partner at Pinnacle Enterprise Risk Consulting Services LLC in Centennial, Colorado.

“This also means referring to ICD-10-CM official guidelines Section I.C.19.g.2 ‘Pain Due to Medical Devices,’” adds Amy Pritchett, CCS, CPC-I, CPMA, CDEO, CASCC, CANPC, CRC, CDEC, CMPM, C-AHI, Senior Consultant at Pinnacle Enterprise Risk Consulting Services LLC, Centennial, Colorado.

The guideline states, “Pain associated with devices, implants or grafts left in a surgical site (for example painful hip prosthesis) is assigned to the appropriate code(s) found in Chapter 19, Injury, poisoning, and certain other consequences of external causes. Specific codes for pain due to medical devices are found in the T code section of the ICD-10-CM. Use additional code(s) from category G89 to identify acute or chronic pain due to presence of the device, implant or graft (G89.18 or G89.28).”

Consequently, your coding for removing a broken or malfunctioning breast implant, depending on patient specifics, could look something like:

• G89.18 (Other acute postprocedural pain) or G89.28 (Other chronic postprocedural pain)
• A specific code from T85.4- (Mechanical complication of breast prosthesis and implant)

And remember this: The CPT^® guidelines for broken breast implant removals can be correlated to the new ICD-10-CM code expansion for C84.7 (Anaplastic large cell lymphoma, ALK-negative), Pritchett notes. That’s because ICD-10-CM 2022 has added C84.7A (Anaplastic large cell lymphoma, ALK-negative, breast), which has the synonym “breast implant associated anaplastic large cell lymphoma (BIA-ALCL).”

“The code carries with it instructions to use additional codes Z98.82 (Breast implant status) and Z98.86 (Personal history of breast implant removal). You should also refer to the ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 Section I.C.2.s.” Pritchett says, which tells you not to assign a complication code from chapter 19 when reporting codes for encounters such as this.