Wiki Capsulorrhaphy/ pocket repair of the breast

[cnagy1979]

I am having difficulty determining the correct CPT code for a capsulorrhaphy of the breast. There doesn't seem to be a specific code for this procedure. Any suggestions?

 

[fwnewbie]

This sounds like a repair of the pocket for a breast implant. Is this reconstructive or a breast augmentation?

 

[cnagy1979]

This is a post breast augmentation pocket repair.

 

[fwnewbie]

Would this procedure only be covered after breast reconstruction following mastectomy? I don't think insurance would cover it if the original surgery was purely cosmetic.

 

[such78]

In a case when the breast implant has ruptured and the implant material extends beyond the capsule, markedly infiltrating surrounding tissue, should I report the removal of implant material in addition to the capsulectomy?

AMA Comment

It would be appropriate to report both the capsulectomy code 19371, Periprosthetic capsulectomy, breast, and the removal of implant material using code 19330, Removal of mammary implant material, given the above circumstances. Otherwise, the capsulectomy code 19371 includes the removal of the old implant material.