CPT Assistant, September 2021, Volume 31, Issue 9, page 13
Question:
May code 19380 (revision of reconstructed breast) be reported with code 11970 (replacement of tissue expander with permanent implant)? Physicians or other QHPs often perform extensive revisions to skin and capsules during this stage of implant reconstruction to reduce the number of revisional surgeries for breast reconstruction patients. Is it correct that code 19380 may only be reported with code 11970 when revisions are performed after the final implant is in place, based on how reconstructed breast is interpreted in the CPT 2021 code set?
Answer:
Yes, it would be appropriate to report code 19380, Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction), with code 11970, Replacement of tissue expander with permanent implant, if extensive capsular revision and soft tissue revisions are performed. Minor capsule and/or soft tissue work is included in code 11970, which is consistent with the work of code 19342, Insertion or replacement of breast implant on separate day from mastectomy. Extensive revisions to the capsule at the time of the tissue expander to implant exchange would be reported separately with code 19370, Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy, in addition to code 11970 or 19342. If extensive capsule and extensive soft tissue work is performed (eg, not simply revising the scar or removing a minor amount of skin), report code 19380 instead of code 19370, because the work of code 19370 is included in code 19380, and code 19380 should be reported in addition to code 11970 or 19342.
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