Wiki Help coding Removal of Tissue expanders

[kristy2]

I code for a plastic surgeon that does mostly breast reconstructions. On a few patients the surgeon has had to remove the tissue expanders that were placed during a previous surgery due to complications or infection. On almost all cases, he has opened the breast capsule, removed the expander, debridement of necrotic tissue attached a wound vac and followed patient closely for later insertion of expander or prosthesis.

I am puzzled coding these surgeries! In my opinion 19328 (removal of intact mammary implant) is not appropriate because they are expanders. 19380 (revision of reconstructed brst) is not appropriate because it is my understanding this is for correction to asymmetry.

I have coded for the removal of tissue expander (11970) with placement of wound vac (97606) in the past. However, we were disappointed in the reimbursement amounts. It was felt that the surgery was more involved and the surgeon should be reimbursed accordingly. So, we then tried billing with mod 22 (with supportive documentation) and even 19499 (unlisted procedure with supportive documentation). It was determined that billing the unlisted procedure with supportive documentation got us the best reasonable reimbursement for the procedures performed.

So.... my question is.... I find that I am spending a great deal of time writing these appeals and proof of documentation. Is there an easier way? Can we bill for the 19328 even though it's a tissue expander and not prosthesis?

 

[swhitus]

Kristy,
This gets a little deep and depending on the Dx and the entire Op note it could go several different directions.

19328 is the removal of intact mammary implant. No replacement or insertion of prosthesis is included in this code. This code is only to be used for removal of intact gel or saline implant or ruptured saline shell. If removal AND replacement at the same time - use 11970 to replace an expander or 19340 to replace an implant (19342, if capsulotomy required to free space to place the implant) This is usually done for cosmetic/symmetry purposes.

19342 Delayed insertion of breast prosthesis following mastopexy, masetectomy or in reconstruction. Delayed means performed at a later date than the mastectomy procedure. This can be used for removal and replacement of ruptured saline implant with capsular modification or replacement of expander where moderate capsular work is required. This is not for use on the non-cancer breast requiring symmetry (use 19325). Some other instances where 19342 would be appropriate would implant exchange, expander removal w/implant insertion. Never bill 19342 w/11970.

You are correct with the 19380. This is a revision of reconstructed breast (bra roll reduction).

11970 is to be used if tissue expander is replaced with permanent prosthesis this includes capsulotomy (19370) and you cannot report separately. Medicare does not recognize code as bilateral so use modifier 59 to indicate second side, if performed.

11971 is used when tissue expander(s) are removed without insertion of prosthesis. This is a unilateral code, Medicare does not recognize code as bilateral so use modifier 59 to indicate second side, if performed. Some carriers may prefer modifier 50 if done bilateral - check with your specific carrier.

Without know full details on the Op note I don't feel comfortable giving you a specific code but from what you've included in your post 19328 would be inappropriate. I think you need to look at 11970 & 11971. I hope this information helps you.