Wiki Removal of ruptured buttock implants

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ctidwell

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Does anyone know which CPT code to use for the removal of bilateral ruptured silicone BUTTOCK implants? They were placed over 30 years ago. The insurance company has already denied an unlisted code.
 
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Have you looked at 20670 ? I know we always affiliate this code with orthopedic hardware, however, the CPT description is non specific so it could be used for non orthopedic implants as well.

Julie, CPC
 
Yes, I looked at that one (20670) and also 20520 and 11971 but the doc doesn't think it accurately describes the procedure and there aren't enough RVUs with any of those for the amount of work he did. I guess I may be stuck using one of these 3 and adding a -22 modifier.
Thank you so much for replying!
 
Yes, that is the one that the insurance company denied. They don't want an unlisted code. But thank you for checking into it!
 
Unlisted code

In my experience the insurance carriers typically just want the operative note and an explanation of why you needed an unlisted code vs an existing code, and on what you based your fee.

So for example, if we take a child to the OR to remove the PEG we use an unlisted code. We base our fee on the fee for suture removal under anesthesia (15850 or 15851). When the claim is questioned I send a letter explaining the need for a trip to the OR for removal with anesthesia in this case and the "equivalent" procedure on which I based our fee, and enclose the op report.

Good luck.

F Tessa Bartels, CPC, CEMC
 
I am surprised that an insurance company would pay for something that sounds like cosmetic surgery to me. Was this implant done for some reason other than cosmetic?
 
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