Wiki Fat Transfer Breast

[ashack63]

Some confusion regarding this CPT code. 3M is bringing up 19366, but policy is to use 15770.
Using blunt flap, the suction cannula and the leuki Katcher, we aspirated approx 100cc of tumescent plus fat......
The fat was then injected with a series of small incisions into the left upper pole in orfer to fill out the contour defects that were previously identified.

This is a post mastectomy patient who had a revision on one breast and this procedure on the other.
If anyone can point me in the right direction so I would feel comfortable using the 15770?

 

[nsteinhauser]

I don't think the 15770 is the appropriate code to use in this case. Here is the lay description for 15770 :
The physician takes a graft composed of derma, fat, and fascia to repair and blend in defects left behind by atrophy, surgical excisions, or other fleshy defects, much like a composite graft. The derma-fat-fascia graft may be a continuous piece of all three of these layers, individual sections done layer by layer, or graft pieces laid in the recipient bed as combinations, such as a fascia-fat layer, followed by a dermal layer. The graft is used on defects much like a composite graft to maintain support for the continuity of the local flesh. The graft is laid in the recipient area so as to fill and blend in pockets of defects to restore the surrounding area to normal positioning and to maintain the continuity of the local flesh.

Here is the lay description for 19366:
The physician excises skin, fat, and/or muscle from another site on the patient for use in the reconstruction of the breast following a modified radical or radical mastectomy. The tissue is excised and the operative wound is sutured in a layered repair. In preparation for the graft, any mastectomy scar is excised. The tissue is transferred to the mastectomy site. The physician adjusts the flap for the most aesthetic appearance and secures it with sutures to the chest wall, adjacent muscles, and skin. An operating microscope may be employed. If the tissue does not have sufficient bulk, a breast implant may be required. The chest incision is repaired with sutures.

Based on these descriptions, the 19366 is the more appropriate code with the -RT or -LT modifier, whichever side it was. Another option is 20926. We need to see the entire (scrubbed) op note. Hope this helps.