Part 3: CPT Breast Education Series | Immediate Versus Delayed Permanent Breast Implant Reconstruction
This is Part 3 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 3 focuses on the difference between immediate and delayed permanent breast implant reconstruction.
In order to assign the appropriate CPT code for breast implant reconstruction following a mastectomy, the coder must first determine if the placement of the implant is immediate or delayed.
When the initial permanent breast implant is inserted immediately following the mastectomy, code 19340 would be used. Immediate insertion also means that the patient did not require a tissue expander as part of a staged reconstruction. In other words, if the patient has had a tissue expander, immediate insertion of breast prosthesis, 19340 will NOT be assigned because the permanent implant insertion was not performed immediately after the mastectomy.
Code 19340 would also be used when a breast implant is inserted after a mastectomy and later is replaced with a new implant. The reasoning is that there was no delay in initial implant reconstruction following the mastectomy. No code would be assigned for removal of the existing implant as this is integral to the replacement. “Once immediate, always immediate”
Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
When the initial permanent breast implant is not inserted immediately following the mastectomy, but at some later date, this represents a delayed insertion. A delayed insertion of a permanent breast implant is assigned code 19342.
Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
A permanent implant placed after use of a tissue expander is always going to be a delayed insertion because it was not done immediately following the mastectomy. This is considered a staged reconstruction – stage one is the tissue expander, stage two is exchange for a permanent implant. This exchange is coded as 11970 and not to 19342. This code will include any minor adjustments to the capsule and other structures in order to facilitate placement of the implant.
Replacement of tissue expander with permanent prosthesis
Once a tissue expander or permanent breast implant is in place, fibrous scar tissue forms around it, creating a tissue capsule. The body forms a protective capsule like this around any object it recognizes as foreign. The tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the expander or implant in place. In some women, a capsule forms that is unusually hard and dense. The capsule tightens around and squeezes the expander or implant. This condition, called capsular contracture, can cause chronic pain and distortion in the shape of the breast, and it can make the breast rise higher on the chest.
There are two procedures that may be performed on this capsule – capsulectomy or capsulotomy.
Capsulectomy – Removal or all or part of the thickened capsule of scar tissue around a breast implant.
Capsulotomy – Making incisions into the breast pocket or capsule to release scar tissue or to increase the dimensions of the pocket to accommodate a larger sized implant.
During an exchange of a tissue expander for a permanent breast implant, some minor adjustments to the capsule are expected. Code 19342 would also be used when the tissue expander exchange requires additional work over and above the minor adjustments to the capsule included in CPT code 11970.
Examples of documentation that coders will want to look for to support code 19342 include:
*thick or tight capsule requiring multiple radial incisions for capsulotomy
*complete, considerable, or extensive capsulectomy
Using code 19342 will account for the additional work performed by the surgeon. A separate code is not assigned for the capsulectomy or capsulotomy. Code 11970 would not be assigned as this would be included in code 19342.
Code 19342 may also be assigned in a case where the patient is undergoing replacement of a breast implant that was originally a delayed insertion. The reasoning is that there since there was a delay in the initial implant reconstruction following the mastectomy, any subsequent implant replacement would also be delayed. “Once delayed, always delayed”
No code would be assigned for removal of the existing implant as this is integral to the replacement.
Part 4 of this series will discuss the use of acellular dermal matrix in breast reconstruction.
CPT Assistant, January 2013, Volume 23, Issue 1, page 15
CPT Assistant, August 2005, Volume 15, Issue 8, pages 1-3
CPT Assistant, August 1996, Volume 08, Issue 6, page 8
The information contained in this series is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
With the creation and implementation of ICD-10-CM, multiple codes are available to describe the type of pulmonary emboli that occur.
Hypercoagulable states are blood disorders that increase the risk of deep vein thrombosis or embolic disease. The state is either inherited or acquired. About 80% of patients with blood clots have been found to have either an inherited or acquired clotting disorder. These blood clots can be lethal and some require life-long therapy. Hypercoagulable state is also known as thrombophilia.
Encephalopathy is a general term and means brain disease, brain damage or malfunction. Physicians often use encephalopathy and altered mental status interchangeably. When coders see this documentation in the healthcare records, they typically need to query the physician for clarification of the diagnosis.
Spinal procedure coding can be daunting for coders. The spine itself can be quite complicated anatomically and the procedures done to address spinal conditions can be even more complicated!
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer.
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.