AHA Coding Clinic® for HCPCS - 2019 Issue 3; For Your Information

CPT codes 19380 vs 19340 and 19371

A morbidly obese patient has undergone preventive bilateral mastectomies due to family history of breast cancer. She has now developed a capsular contracture on both mammary prostheses causing pain and a rock-like feeling on the left. The right implant has been pushed out of location. The patient presents for revision of both reconstructed breasts. The right scar was resected, the muscle fibers were split and once the pocket was opened the implant was found to be upside down and severely constricted by the capsule. The breast implant removed was in working order. An aggressive capsulectomy was performed and the previous flap was resected for better position. The implant was replaced back into the pocket over a drain and the muscle layer was repaired. The right chest wall incision was closed. Attention was turned to the left breast. A lateral incision was made to expose the pectoralis muscle which was split and the capsule was entered. The implant was found to be upside down but in working order. The left breast implant was removed. A thick capsule contracture was widely resected to allow room for the implant. A drain was inserted into the muscle layer and then repaired. A flap was resected and the layers were sutured close. Our facility needs clarification regarding the correct codes based on AHA’s Coding Clinic for HCPCS and CPT Assistant advice. Our facility wants to report CPT codes 19371 and 19340 or 19380 and append modifier 50. However, we are confused which code(s) are more appropriate based on previously published advice. ...

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