Wiki breast tissue expander/implant exchange

[tabithal]

Is coding out both 11970 and 19370 unbundling, or is that generally ok? The exchange (11970) always involves a capsulotomy (19370). Sometimes more extensive capsulotomy is required, sometimes almost nothing. I searched this but couldn?t find a consistent answer. Some references say to just code 11970 for any breast TE-implant exchange no matter how much capsulotomy is required. Some say add 19370-59 if a more extensive capsulotomy is needed.

Any thoughts on this?

 

[CVR]

Look at 19342-
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. in this case you would use 19342