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CODING & BILLING
Denis Rodriguez, CPC-H
Inside Breast Reconstructions and Revisions
Your guide to getting reimbursed for breast surgery.
B
reast surgery can be a challenge to code. Some payers, for
example, won't cover reconstructive procedures on prior
breast augmentations, while others will cover the reconstructive procedures, but not the implant replacement. Here's the latest
on recent coding clarifications, as well as important details regarding implants and payer considerations.
Medicare Reimbursement for Breast Surgery
As the field of breast reconstruction and revisional surgery has evolved,
so, too, have breast surgery CPT codes in both their purpose and intent.
Procedure
Autologous fat transfer
19366
$1,379.81 $2,458.99 0029 Yes
Tissue expanders
19357
$3,565,14 $4,562.00 0648 Yes
Soft tissue reinforcement
15777
$623.76
Replacement of tissue expander
with permanent prosthesis
11970
$1,928.93 $3,437.59 0051 Yes
Revision of reconstructed breast
19380
$1,815.79 $3,235.96 0030 Yes
Nipple/areola reconstruction
3 2
CPT Code ASC
OPPS
APC Multiple
Discount
19350
$1,045.25 $1,862.77 0028 Yes
$1,111.61 0136 Yes
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013
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