AHA Coding Clinic® for HCPCS - 2019 Quarter 3; For Your Information
CPT codes 19380 vs 19340 and 19371
A morbidly obese patient has undergone preventive bilateral mastectomies due to family history of breast cancer. She has now developed a capsular contracture on both mammary prostheses causing pain and a rock-like feeling on the left. The right implant has been pushed out of location. The patient presents for revision of both reconstructed breasts. The right scar was resected, the muscle fibers were split and once the pocket was opened the implant was found to be upside down and severely constricted by the capsule. The breast implant removed was in working order. An aggressive capsulectomy was performed and the previous flap was resected for better position. The implant was replaced back into the pocket over a drain and the muscle layer was repaired. The right chest wall incision was closed. Attention was turned to the left breast. A lateral incision was made to expose the pectoralis muscle which was split and the capsule was entered. The implant was found to be upside down but in working order. The left breast implant was removed. A thick capsule contracture was widely resected to allow room for the implant. A drain was inserted into the muscle layer and then repaired. A flap was resected and the layers were sutured close. Our facility needs clarification regarding the correct codes based on AHA’s Coding Clinic for HCPCS and CPT Assistant advice. Our facility wants to report CPT codes 19371 and 19340 or 19380 and append modifier 50. However, we are confused which code(s) are more appropriate based on previously published advice. ...
Subscribe or sign in to view the full article.
Article Overview
This premium article reviews a breast reconstruction case involving implant revision after prior mastectomy, with attention to how CPT breast reconstruction and revision codes may be compared in a complex operative scenario. It is aimed at coding professionals, auditors, and reimbursement staff who need to understand how revision-related breast procedure reporting is evaluated in context. The article focuses on procedure context, operative findings, and code selection considerations for breast implant revision work.
Why This Topic Matters
Breast reconstruction revisions can involve overlapping procedure categories, and accurate CPT interpretation is important for compliant reporting and claim support. This article helps readers understand the coding relevance of a detailed operative scenario involving implant position, capsule work, and reconstruction revision.
Article Sections
-
Clinical case and operative revision narrative
A postoperative breast reconstruction scenario is described, including bilateral revision findings and the operative steps performed during the encounter. The narrative provides the clinical context used to evaluate the coding question.
-
Coding comparison discussion
The article examines how the relevant CPT breast reconstruction and revision codes are being compared for the reported procedure context. It is intended to clarify the scope of the coding discussion without reproducing the article's conclusions.
What You Will Learn
- How a breast reconstruction revision case is framed for coding review
- What procedural context is relevant when comparing CPT breast implant and revision codes
- How operative details support evaluation of a complex reconstructive surgery encounter
- What types of documentation issues arise in implant-related breast revision cases
Who Should Read This
- Medical coders
- Coding auditors
- Revenue cycle professionals
- Physician practice managers
- Breast surgery billing staff
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com