Wiki Breast Reconstruction with Capsulectomy

Create Wiki
J

jhartung

Networker
Messages
26
Location
Hudson Falls, NY
Best answers
0
My provider often performs a capsulectomy (19371) before doing a breast revision (19380). Empire Blue Cross specifically will not pay for the 19371 because they state it is included in the 19380. However, I cannot find any documentation that either confirms or denies this, any thoughts?
 
our office performs these procedures as well. there isn't a CCI edit when billing both codes together, but we bill one or the other. since there is a definitive code for a capsulectomy, i would go with 19371 - i.e. capsulectomy w/removal of implant/expander, ruptured implant w/in the capsule, etc. i'd also bill 19340 if another implant is replaced. we bill 19380 for removal of tissue/skin, capsulorraphy, or adjustments made in breast pocket.
 
Capsulotomies with removed of tissue expanders and placement of implants

If the physician performs extensive capsulotomies, removes tissues expanders replacing them with implants, and performs axillary liposuction -- 19370, 19342, 11970, 15877.

Does 19380 include the capsulotomies? The way I read 19380 is that the physician is performing revision of breast where implants have already been placed. It talks about tissue rearranged and the existing prosthesis being replaced by a prosthesis of a different configuration.

Any help would be appreciated.
 
Last edited:
If the physician performs extensive capsulotomies, removes tissues expanders replacing them with implants, and performs axillary liposuction -- 19370, 19342, 11970, 15877.

Does 19380 include the capsulotomies? The way I read 19380 is that the physician is performing revision of breast where implants have already been placed. It talks about tissue rearranged and the existing prosthesis being replaced by a prosthesis of a different configuration.

Any help would be appreciated.
__________________

JBowyer
 
You must log in or register to reply here.
Top