AHA Coding Clinic® for HCPCS - 2017 Quarter 1; Ask the Editor
Excision of breast capsule
Patient with a history of breast cancer and bilateral mastectomies and reconstruction presents for excision of the left breast capsule and aspiration of seroma/fluid on the right side. However, the patient had the tissue expanders and the implants removed on a previous visit. The capsule within the open wound on the left side was excised completely and closed with suture. On the right side a needle was utilized to drain serous fluid from the pocket. The patient tolerated the procedure well. Would CPT code 19371 be the appropriate code to assign for the excision of the breast capsule where no expanders or implants are in place? ...
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Article Overview
This premium article examines a postoperative breast reconstruction scenario and the coding considerations for capsule excision when prior reconstruction devices are no longer present, along with drainage of serous fluid from a breast pocket. It is intended for coders, billers, and revenue integrity staff working with breast reconstruction, postoperative complications, and procedure code selection. The article focuses on how to think about the reported services in a clinical context and the CPT framework involved.
Why This Topic Matters
Breast reconstruction cases can involve layered postoperative findings, prior device removal, and separate procedures that affect code assignment. Understanding the article helps coding professionals identify the relevant CPT considerations for these scenarios and review whether the reported services align with the documented procedure.
What You Will Learn
- How a breast reconstruction postoperative scenario is framed for coding review
- The types of procedure considerations raised by capsule excision and fluid drainage
- How CPT coding questions are presented in relation to prior implant or expander removal
- What documentation context is relevant when evaluating separate services in a breast pocket or capsule setting
Who Should Read This
- Medical coders
- Coding auditors
- Revenue cycle staff
- Compliance staff
- Physician billing staff
Codes Discussed
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