Cosmetic Surgery Tips

Coding Breast Reconstruction Procedures

Breast reconstruction is a procedure that women can undergo after mastectomy. It involves the use of either autologous or allogeneic tissue to rebuild the shape and size of the breast.

There are several types of breast reconstruction procedures, each with their own advantages and disadvantages. We offer a variety of different reconstructive options for our patients, including:

-The DIEP flap procedure: The DIEP flap procedure uses donor tissue from the patient’s abdomen to rebuild the breast mound. This method provides great results but requires more time to heal and requires longer incisions than other methods.

-The TRAM flap procedure: The TRAM flap procedure is similar to DIEP flap surgery, but uses tissue from the lower abdomen instead of abdominal fat. This method also has a high success rate, but requires more time to heal than other options because of its longer incisions.

-The immediate expander system: This system involves surgically inserting an implant immediately after mastectomy so that it can start healing right away. Immediate expander surgery is less invasive than other methods but may not provide as good results over time due to its limited amount of healing time before surgery begins again.

Coding Breast Reconstruction Procedures

CPT Code Updates

Plastic surgery offers women various options to change the appearance of the breasts such as breast augmentation, breast reconstruction, breast reduction and breast lift. In 2021, there are major changes to CPT codes for breast procedures which include 15 revised codes and two deletions. Expert coders in medical billing companies are up-to-date on all the new changes and can help physicians select the correct codes based on these updates, which is important to avoid audits and get timely reimbursement.

  • Breast Augmentation (Code 19325): Breast augmentation is a popular cosmetic surgical procedure that typically involves using FDA-approved implants to enhance the size and shape of a woman’s breasts. Breast enhancement may be also performed using fat from the patient’s own body. Fat grafting is often combined with implant surgery to enhance the results.

    Updates for Breast Augmentation Coding:
    • The language of the code descriptor for CPT 19325 has been simplified.
    • CPT codes 15771 (Grafting of autologous fat harvested by liposuction technique) and 15772 (add-on code for autologous fat grafting to the trunk, breasts, extremities, or scalp for each additional 50cc of injectate) can be used to report fat grafting to the breast.
    • A parenthetical has been added instructing users to report codes 15771 and 15772 when fat grafting is performed in conjunction with breast augmentation.
    • Deleted: 19324 Mammaplasty, augmentation without prosthetic implant.
  • Breast Reconstruction: Breast reconstruction involves rebuilding the breast(s) after mastectomy. This is usually done during or soon after mastectomy, but can also be performed many months or even years after the removal of the breast. Payers reimburse breast reconstruction after mastectomy performed for a medical reason as it is considered a relative safe and effective non-aesthetic procedure.

19380 Cpt Code


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    Applicable Codes with the Revised Descriptors19328 Removal of intact mammary implant
    19330 Removal of mammary implant material
    19340 Insertion of breast implant on same day of mastectomy (i.e., immediate)
    19342 Insertion or replacement of breast implant on a separate day from the mastectomy
    19350 Nipple/areola reconstruction
    19357 Tissue expander placement in breast reconstruction, including subsequent expansion (s)
    19361 Breast reconstruction; with latissimus dorsi flap
    19364 Breast reconstruction; with free flap (eg, TRAM, DIEP, SIEA, GAP flap)
    19367 Breast reconstruction; with single-pedicled transverse rectus abdominismyocutaneous (tram) flap
    19368 Breast reconstruction; with single-pedicled transverse rectus abdominismyocutaneous (tram) flap, requiring separate microvascular anastomosis(supercharging)
    19369 Breast reconstruction; with bipedicled transverse rectus abdominis myocutaneous(tram) flap
    19370 Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy,and/or partial capsulectomy
    19371 Peri-implant capsulectomy, breast, complete, including removal of all intracapsularcontents
    19380 Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction
    19396 Preparation of moulage for custom breast implant
    Deleted: 19366 Breast reconstruction with other technique
  • Codes 19340 and 19342 – Implant placement in breast reconstruction: The codes are used for placement of a new implant or replacement in mastectomy or reconstructed breast. Both codes now have simplified descriptors and term “breast implant” is used in place of the term “breast prothesis”. The code selection depends whether the reconstruction was done immediately after the mastectomy or on a separate day from the mastectomy. There is a new parenthetical which states that 19342 and 19328 should not be reported in conjunction for removal of implant in the same breast. CPT code 11970 should be used for removal of tissue expander and replacement with a breast implant.
  • Code 19357 is separately reportable if used in flap reconstruction, such as a lat dorsi flap (19361).
  • Code 11971 has a change in the descriptor, where the term breast implant” has replaced the term “breast prothesis”. Code 11971 should not be reported in conjunction with 11970. If more-extensive capsular revisions are performed, use code 19370.
  • Code 19370 – Revision of breast capsule. The important change for code 19370 is that in addition to being used for capsulotomies, it is also used to report revisions of peri-implant capsule including capsulotomy, capsulorraphy and/or partial capsulectomy. When placing a new implant, code 19342 can be separately reported. if the capsular work performed is significant, code 19370 can be reported with tissue expander exchange. Code 19370 cannot be reported in conjunction with CPT 19328 for removal and replacement of the same implant to access the capsule.
  • Code 11971 – Removal of a tissue expander. The only change for code 11971 is that the word “prosthesis” has been replaced by “permanent implant”. For removal of a breast tissue expander and replacement with a breast implant, use code 11971.
  • Mastopexy (Breast Lift) & Breast Reduction (Codes 19316 & 19318) – A mastopexy is a surgical procedure to lift the breasts to a more aesthetically pleasing position. A breast reduction is performed to reduce the size of overly large breasts. Code 19316 Mastopexy remains unchanged. In the descriptor code 19318, the word “reduction mammoplasty” has been changed to “breast reduction”.

The above-listed codes are not all-inclusive. Plastic surgery practices also need to be knowledgeable about the important E/M coding updates that came into effect in 2021. Partnering with a medical billing company with expertise in plastic surgery medical billing and coding is the best way for practices to ensure that services provided are reported using the appropriate codes. The support of an experienced service provider can be very valuable as physicians and practices deal with the impacts of the novel coronavirus pandemic.

CPT Code For Breast Implant Removal And Replacement

The new notes under the codes advise coding professionals to report 19342 for removal and replacement with new implant. A quick glance of the code description for 19342 reveals that this is for insertion or replacement of breast implant on separate day from mastectomy.

The new notes under the codes advise coding professionals to report 19342 for removal and replacement with new implant. A quick glance of the code description for 19342 reveals that this is for insertion or replacement of breast implant on separate day from mastectomy.

In the field of medical coding, accurate reporting is crucial for ensuring proper reimbursement and compliance with regulations. The updated guidance on reporting code 19342 for removal and replacement with a new implant emphasizes the importance of specificity in coding procedures involving breast implants. This code is specifically designated for cases where the insertion or replacement of a breast implant is performed on a separate day from a mastectomy procedure.

Coding professionals must pay close attention to the details of the documentation to ensure that the correct code is selected. In the case of code 19342, it is essential to verify that the removal and replacement of the breast implant are performed on different days than the mastectomy. This distinction is critical for accurate reporting and reimbursement purposes.

When reporting code 19342, coding professionals should consider the following key points:

– The procedure involves the removal and replacement of a breast implant.
– The removal and replacement are performed on different days from a mastectomy procedure.
– Accurate documentation is essential for proper code selection.

By following these guidelines and reviewing the code description for 19342, coding professionals can ensure that the procedures involving the removal and replacement of breast implants are accurately reported. This will help to facilitate proper reimbursement for the services rendered and maintain compliance with coding regulations.

In summary, the new notes advising coding professionals to report 19342 for removal and replacement with a new implant highlight the importance of precise documentation and code selection in the field of medical coding. By paying attention to the specific details of the code description and following established guidelines, coding professionals can ensure accurate reporting and compliance with coding regulations.

CPT Code For Breast Reconstruction With Tissue Expanders

For individuals undergoing breast reconstruction after mastectomy, staged reconstruction is a common approach. This type of reconstruction involves the initial insertion of a tissue expander, which is coded as CPT code 19357. The use of tissue expanders allows for a gradual expansion of the breast tissue, creating a pocket for a permanent breast implant.In the staged reconstruction process, the tissue expander is inserted during a surgical procedure following the mastectomy. The expander is then gradually filled with saline solution over a period of weeks to months, stretching the skin and muscle to create space for the final breast implant. Once the desired size is achieved, the tissue expander is removed and replaced with a permanent implant.CPT code 19357 specifically refers to the insertion of the tissue expander at the initial stage of the reconstruction process. This code is used by healthcare providers to bill for the procedure and is essential for accurate documentation and reimbursement.It is important for healthcare providers to properly document the insertion of the tissue expander using CPT code 19357 to ensure proper billing and reimbursement. Additionally, understanding the coding guidelines and documentation requirements for staged breast reconstruction procedures can help streamline the billing process and minimize errors.

CPT Code Description
19357 Insertion of tissue expander for breast reconstruction

Overall, staged reconstruction using a tissue expander is a common approach to breast reconstruction after mastectomy. Proper coding and documentation of the insertion of the tissue expander are essential for accurate billing and reimbursement in healthcare settings.

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