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CODING & BILLING
hour and some can take up to 6 hours, increasing both the risk to
the patient and the expense to the facility. Pay careful attention to
patient selection criteria, and closely analyze the operating expenses for this procedure before adding it to your facility's offerings.
Internal tissue expanders
To prepare a mastectomy patient for subsequent breast implants, it's
common to place internal tissue expanders. Whether it's performed
immediately after mastectomy or it's delayed until chemotherapy or
radiation therapy treatments are completed, use 19357 [Breast reconstruction, immediate or delayed, with tissue expander, including subsequent
expansion] to report this procedure. When performed in an ASC, the
Medicare national payment rate for 19357 is $3,565.14. Under the
Medicare ASC payment system, this code has a payment indicator of
J8, meaning it's a device-intensive procedure and payment for the
expanders is included in the procedure fee. When performed in a hospital outpatient department, OPPS assigns this code to APC 0648,
which is paid at $4,562.00. Report C1789 for each implant in the
HOPD setting; but because OPPS assigns an N status indicator to this
code, its payment is considered packaged into the fee for the main
procedure. Whether done at an ASC or HOPD, the multiple procedure
discount applies. Report the expanders to C1789 [Prosthesis, breast
(implantable)] or L8600 [Implantable breast prosthesis, silicone or equal]
because most payers that don't package or bundle them into the surgical fee, as the expander is, in essence, an adjustable saline breast
prosthesis.
Soft tissue reinforcement
Use 15777 to report any soft tissue reinforcement of the breast with
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