Part 6: CPT Breast Education Series | Revision of Breast Reconstruction
Revision surgery on a reconstructed breast is designed to fine-tune the reconstruction in order to improve the overall cosmetic appearance. Some typical procedures that may be performed include adjustments to the inframammary crease, repositioning the breast, capsular adjustments, liposuction or fat grafting, trimming of excess skin, replacement of implant, and scar revision.
Please note that surgeons may use the term Revision when reconstruction has not been completed. For example, if the patient has a temporary tissue expander and has not undergone stage two with permanent implant placement, the reconstruction is not complete. For coding purposes, Revision refers to adjustments on an already reconstructed breast. Reconstruction is complete when a permanent implant is inserted, or an autologous flap has been inset. There should be nothing left to do except cosmetic adjustments later.
Code 19380 is used for the many procedures that may be done as part of a revision procedure after final reconstruction is complete. Separate codes would not be assigned for each component procedure. As an example, if a reconstructed breast has fullness that requires liposuction, the coder would not assign code 15877. The only code needed is 19380 for Revision of reconstructed breast.
Replacement of a permanent breast implant is not included in code 19380. If the patient is having a new implant inserted, perhaps to a different size, either code 19340 or 19342 can be assigned separately. The code will depend on whether the initial implant was an immediate or delayed insertion.
Revision of reconstructed breast
This concludes this 6-part series on coding for breast reconstruction procedures. There are a limited number of codes available for these reconstruction procedures. Coders will need to be alert to slight differences in code descriptions that will affect code assignment, such as immediate versus delayed insertion, pedicle versus free flaps, or revision of reconstructed breast. Appropriate coding will require coders to correctly interpret the procedure performed.
Coding Clinic for HCPCS, Third Quarter 2019: Page 13
CPT Assistant, December 2017, Volume 27, Issue 12, page 13
Coding Clinic for HCPCS, 4Q 2017, p 6
CPT Assistant, December 2015, Volume 25, Issue 12, page 18
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.
Wow, have you seen the proposed rule for FY2023 IPPS yet? There are 1,495 proposed coding changes to ICD-10-CM diagnoses codes alone! There are also some IPPS changes to note. As for ICD-10-PCS, there are not as many new codes, most significantly occlusion of prostate artery and knee joint replacement codes.
Coding denials are sent after the auditor has reviewed the record in question and the auditor does not agree with the DRG that was paid. This can be for either a diagnosis or a procedure code that they think does not meet reporting requirements.
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As of April 1, 2022 discharges, the following changes in ICD-10 and IPPS will be implemented. For years the coding community did not see changes occurring in April of the fiscal year. HIM professionals were used to not even worrying about April changes. This year, we do have some significant code additions and a change in the IPPS CC/MCC edit. The ICD10MCE and Grouper Version will be 39.1.
DRG 640 (Miscellaneous disorders of nutrition, metabolism, fluids, and electrolytes with MCC) was the number 9 most common DRG with recommendations from HIA in 2021.
DRG 981 (Extensive O.R Procedures unrelated to principal diagnosis with MCC) was the number 8 most common DRG with recommendations from HIA in 2021.
DRG 291 (Heart failure with shock with MCC). This should be no surprise to coders that DRG 291 is in the top DRG’s with recommendation. It seems to always be in the top 5 and a focus for denials.
DRG 177 (Respiratory infections and inflammations with MCC) and 178 (Respiratory infections and inflammations with CC). This should be no surprise to coders that DRG 177 is in the top DRG’s with recommendation.
Sepsis is and will most likely always be a troubled area for coders. There are multiple reasons for this and we will look at a few of these. There are many different criteria being used to validate the diagnosis of sepsis.
During a recent review of spinal fusion cases at a client, we found coding issues on the cases in which both an anterior interbody fusion, anterior open approach was done on one day and two days later, the patient was brought back for a posterior fusion, posterior open approach. Below are some of the recommendations we made along with education explanations.
This is Part 5 of a five part series on the new 2022 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 5 part series on the new 2022 CPT codes. In this one we will explore the nervous, ocular and auditory systems CPT changes.
This is Part 3 of a 5 part series on the new 2022 CPT codes. In this one we will explore the digestive, urinary and reproductive system CPT changes.
This is Part 1 of a five part series on the new 2022 CPT codes. In this series we include examples to help the coder understand the new codes.
10 ICD-10 Codes from the Christmas movie Home Alone. T20. 10XA for Harry, Burn of first degree of head, face, and neck, unspecified site, initial encounter. T20.56XA for Kevin and his aftershave incident, Corrosion of first degree of forehead and cheek, initial encounter.
Did you get a chance to read the FY2022 IPPS Final Rule? There is an interesting topic that was discussed regarding unspecified ICD-10-CM laterality diagnosis codes, to be exact. In this coding tip we discuss that subject and possible ramifications of it in the coding world.
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.