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CODING & BILLING
ent to nipple/areola
reconstruction is
included in this code
and not separately
reported, according
to the January 2013
CPT Assistant.
Medicare Reimbursement for Capsulotomies,
Capsulectomies and Implant Removal
CPT Code
ASC
OPPS
APC Multiple
Discount
19328
$1,379.81
$2,458.99
0029 Yes
19342
$3,565.14
$4,562.00
0648 Yes
19370
$1,379.81
$2,458.99
0029 Yes
19371
$1,379.81
$2,458.99
0029 Yes
Communicate with the payer
Payers differ on the types of procedures they cover and how they want
certain procedures reported. Be sure to get your breast procedures preauthorized in writing. Your request for pre-authorization should clearly
and accurately describe the procedures you intend to perform. Coding
accurately for breast reconstruction and revision can be a challenge, but
with a clear understanding of coding guidelines, detailed and thorough
documentation of the procedures and a pre-authorization process in
place, your facility can get reimbursed its fair due for these procedures.
OSM
Mr. Rodriguez (drodriguez@coding network.com) is senior ambulatory
surgery center coder and compliance auditor with The Coding Network.
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
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