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Medical Coding: 4 Tips To Eliminate Your Breast Implant Coding Challenges

Posted on 03. Jun, 2010 by in Hot Coding Topics

Don’t lose 19342 pay for delayed insertion.

Your general surgeon may perform breast reconstruction following cancer, infection, trauma, or burns, or in some cases, strictly for cosmetic reasons. Make sure you capture appropriate implant pay, when that’s part of the surgical scheme, by following our experts’ tips.

Tip 1: Prosthesis’ Purpose Drives Coding

Breast implants commonly serve two functions — cosmetic breast enhancement or breast reconstruction following a disfiguring event such as mastectomy for cancer or a traumatic injury.

CPT divides implant codes based on the function, so that’s the first distinction you need to make when selecting the proper code.

Differentiate augmentation: Use 19325 (Mammoplasty, augmentation; with prosthetic implant) when the surgeon implants a breast prosthesis for breast enlargement. “Code 19325 describes cosmetic implants only,” emphasizes John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop and Associates.

When the surgeon implants a prosthesis to reconstruct...

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