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CODING & BILLING
biologic implants such as Alloderm or Dermagraft. You must report
this add-on code along with the code for the main procedure (19357,
for example). Some payers may deny payment for the soft tissue reinforcement code, but may pay for the biologic implant tissue, says
Raymond Janevicius, MD, the American Society of Plastic Surgeons's
representative to the American Medical Association's CPT Advisory
committee.
Revision of the reconstructed breast
Although more a staged procedure than a revisional procedure, we're
including code 11970 [Replacement of tissue expander with permanent
prosthesis] because it's often accompanied by revisional procedures
that can make coding these procedures complicated.
After a tissue expander has adequately created a space for implant
placement, the surgeon will bring the patient in for removal of the
expander and placement of the permanent implant. Code 11970
includes minor adjustments to the capsule during the expander
removal and implant placement. However, significant adjustments
such as lowering or raising the inframammary crease, significant partial or total capsulectomy, or multiple capsulotomies to achieve symmetry or accommodate the prosthesis aren't included in code 11970,
according to the January 2013 CPT Assistant. In such a case, some
payers require the procedure to be reported to 19342, as the AMA recommends, while others may prefer the reporting of 11970 along with
the capsulotomy or capsulectomy codes, says Dr. Janevicius. He adds
that the extent of the capsulotomies and capsulectomies should be
well described in the note. Document the area being adjusted along
with the intent and/or effect of the procedure; a statement such as
"capsulotomy was performed" does not suffice. Because code 19342
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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
