Correction: Replacement of tissue expander with implant

In the Fourth Quarter 2020 Issue of Coding Clinic for HCPCS, Page 3, the third question included in the article on “Coding Breast Revision Procedures” indicated that CPT code 19342 , Insertion or replacement of breast implant on separate day from mastectomy, was assigned for removal of a tissue expander with insertion of a breast implant with capsulorrhaphy. When replacing a tissue expander with a breast implant, CPT code 11970 ,  Replacement of tissue expander with permanent implant,  is the correct code. Therefore, based on the updated CPT guidelines for 2021, the correct codes to capture replacement of...

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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This short correction explains that the article revisits a prior breast reconstruction coding scenario and clarifies the applicable CPT guidance discussed for 2021. It is relevant to coders, billers, and reimbursement staff working with breast revision procedures, tissue expanders, implants, and related edit/payer-policy considerations. The piece also notes that an NCCI edit may affect reporting and that payer requirements can vary.

Why This Topic Matters

Accurate procedure coding and awareness of claim edits are important for compliant reporting and reduced denial risk in breast reconstruction cases.

What You Will Learn

  • How a prior breast revision coding scenario is corrected under updated CPT guidance
  • Which general procedure categories are implicated in replacement of a tissue expander with an implant
  • How coverage/edit considerations may affect reporting and payer follow-up
  • Why updated coding references can change reporting for breast reconstruction-related procedures

Who Should Read This

  • Medical coders
  • Billing staff
  • Revenue cycle professionals
  • Compliance personnel
  • Plastic surgery practices
  • Hospital outpatient coding staff

Codes Discussed


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