The original post was long ago, but I thought it worth updating
The answer is 19342. This includes removal of the existing implant/TE and revision to the breast to accommodate and properly seat the new implant.
CPT Assistant
Year: 2013
Issue: January
Pages: 15-16
Title: Frequently Asked Questions
Body:
Surgery: Integumentary System
Question:The August 2005 edition of the CPT Assistant (page 2) included the reporting of temporary tissue expander replacement, as excerpted:“If a temporary tissue expander has been used, it is removed after the skin has stretched sufficiently and is replaced with a permanent breast prosthesis during a second operation. This procedure is generally coded [with code] 11970, Replacement of tissue expander with permanent prosthesis. Code 11970 is a global service 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.” Would the reference to the “considerable capsular adjustments” involve capsulotomy or capsulectomy for which code 11970 may be reported in addition to code 19371, Periprosthetic capsulectomy, breast?
Answer:No. It was intended that code 11970 includes some minor adjustments to the capsule. However, when significant adjustments are made to the capsule, many of which comprise a significant part of the procedure, and when appropriately documented, code 19342, Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction, may be reported to represent the additional maneuvers that involve more surgeon time and work. For example, sometimes the capsule must be significantly modified, the infra-mammary crease must be lowered or raised, or partial or total capsulectomy must be performed.
Another example of the type of work associated with the use of code 19342 is breast reconstruction with expander in a patient undergoing postoperative expansion. When the tissue expander is replaced, it may be that the capsule is found to be very tight and multiple radial incisions may be required in the capsule to accommodate the permanent prosthesis and form a symmetric contour to the opposite breast. CPT code 11970 alone does not account for this additional work, which is over and above removal of an expander and replacement with a permanent implant.