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CODING & BILLING
includes considerable
capsular adjustments
in preparation for
delayed implants, you
wouldn't code capsulotomies in addition.
When coding for
capsulotomies, capsulectomies and
implant removal,
keep these guidelines
in mind:
• Code 19371
[Periprosthetic capsulectomy, breast]
includes the removal
of a breast implant
and any extravasated
implant material that
remains within the
capsule, so don't
report 19328 [Removal
of intact mammary
implant] in addition.
When you perform
capsulectomy with
removal of implant
material extending
beyond that capsule,
Medicare Reimbursement for
Replacement Breast Implants
CPT Code
ASC
OPPS
APC
19325
$3,565.14
$4,562.00
0648
19340
$1,815.79
$3,235.96
0030
RECONSTRUCTIVE OR COSMETIC?
How to Code
Replacement Breast Implants
L
et's say you replace breast implants during
the same session as a reconstructive procedure. How would you correctly code this? It
all depends on the original purpose for the implants.
If the intent of the original implants was cosmetic augmentation, then report code 19325
[Mammaplasty, augmentation; with prosthetic
implant] for implant replacement. However, if the
original purpose of the implants was reconstructive in nature, you'd report code 19340 [Immediate
insertion of breast prosthesis following mastopexy,
mastectomy or in reconstruction.]
S E P T E M B E R 2013 | 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
— Denis Rodriguez, CPC-H
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