Do Away With Your Breast Implant Coding Challenges

By Author: Nancy Rose
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Do not miss out on 19342 pay for delayed insertion.


Your general surgeon may carry out breast reconstruction after cancer, infection, trauma or burns, or in few cases, firmly for cosmetic reasons. See to it that you capture appropriate implant pay, when that is part of the surgical scheme by going through our experts' tips.


Tip 1: Prosthesis' purpose drives coding


Normally, breast implants serve two functions - cosmetic breast enhancement or breast reconstruction following a disfiguring event like mastectomy for cancer or a traumatic injury.


CPT divides implant codes based on the function so that it is the first distinction you require to make when choosing the right code.


Distinguish augmentation: Report 19325 (Mammoplasty, augmentation; with prosthetic implant) when the surgeon implants a breast prosthesis for breast enlargement. Code 19325 talks about cosmetic implants only," stresses John F. ...
... Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop and Associates.


When the surgeon implants a prosthesis to reconstruct the breast following mastectomy, you need to see elsewhere for a code. For instance for silicone or saline implants involved in reconstruction, CPT provides the following codes:


19340 — Immediate insertion of breast prosthesis after mastopexy, mastectomy or in reconstruction
19342 — Delayed insertion of breast prosthesis after mastopexy, mastectomy or in reconstruction.


Tip 2: Timing is be all and end all for implant placement


CPT provides 19340 and 19342 for breast prosthesis associated with mastectomy or mastopexy. You will decide between those two codes based on when your surgeon carries out the implant procedure.


How it functions: For patients whose physiology will accommodate a full-size saline - or silicone-filled prosthesis, the surgeon may place the implant right away following the mastectomy. If the surgeon inserts a breast implant at the same operative session as the mastectomy, you should report 19340," says Bishop. For our mastectomy patients chose for reconstruction, immediate treatment is the most common option," Lynn Woolard, practice manager for General and Vascular Surgery in Elgin, Ill. says.


Look for ‘delayed' code: Conversely, the surgeon sometimes closes the surgical site following mastectomy and the patient goes home to nurse back to health for some period of time. If later on the patient comes back for breast reconstruction that involves implant placement, you should list 19342 for the insertion. Making use of this code correctly is important as the procedure is more complicated and pays more, according to Bishop - $725 for 19340 versus $868 for 19342, based on the Medicare physician fee schedule facility national values with the help of conversion factor 36.0846.