Coding Breast Procedures

In this edition of “Spotlight on CPT” we will take a look at the revised CPT codes for breast procedures. 

Found in the Integumentary Section of CPT, codes for breast procedures saw a number of revisions for 2021.  Some of the revisions centered around terminology, such as with codes 11970 and 11971 where, in both codes, the term “prosthesis” was replaced with the term “implant”.  Other codes saw the term “mammary” replaced by the word “breast”.   

However, there were other, more substantive changes that occurred as well.  Let’s begin by looking at one of the codes that was deleted from the Repair/Reconstruction subsection for breast procedures which is code 19324.  That code was for breast augmentation done without an implant.  A note now directs coding professionals to use either 15771 or 15772 for fat grafting performed for breast augmentation. 

Revisions of codes 19340 and 19342, which identified either immediate or delayed implantation of a breast prosthesis, now state “on same day of mastectomy” (19340) or “on separate day from mastectomy” (19342).  Reference to an “immediate” or “delayed” time frame was deleted from code 19357 related to insertion of tissue expanders.

Breast reconstruction procedures performed with flaps are identified by type of flap and no longer reference implants.

19361                   Breast reconstruction; latissimus dorsi flap

19364                   free flap (eg. fTRAM, DIEP, SIEA, GAP flap)

19367                   single-pedicled TRAM flap

19368                   single-pedicled TRAM flap requiring microvascular anastomosis

19369                   bipedicled TRAM flap

Notice that code 19366 has been deleted.  This code previously identified breast reconstruction with other technique.

Code 19370, which had been for a periprosthetic capsulotomy, now includes more detail.  The full definition is “Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy.”  Similarly, peri-prosthetic capsulectomy code 19371 has been changed to read “Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents.” 

The final revision in this section is added detail to code 19380 for revision of reconstructed breast.  Now we have the following information as to what is included in this code “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.”

Now, light has been shed on coding breast procedures.

 

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

Park Predicaments

by Dianna Foley, RHIA, CHPS, CCS

Test your ICD-10-CM coding skills with this Klutz family experience.

The Klutz family was enjoying a Saturday afternoon in the park.  After a picnic lunch, each of the children was busy playing while their parents enjoyed a leisurely stroll.  As the parents began gathering belongings in preparation for the return home, a series of events necessitated (you guessed it!) a trip to the emergency room with all the children.  Let’s take a closer look at what happened.

Peter was riding his bicycle through the park when he attempted to jump over a rather large log path.  The bike crashed down, tossing him off.   He began wailing in pain and grabbed his left shoulder.  Egon, who was skateboarding at the time, became distracted at the sound of his brother’s cries and didn’t see the large rock in the skate park area.  His skateboard hit the huge rock and he fell to the ground.  His cries joined his brother’s as he grabbed his right knee.  Startled when she heard the cries, little Dana fell off the swing ending up with her own tears as she grabbed her right wrist, which she landed on when she fell.  Raymond had been climbing on the jungle gym when all the hoopla started.  Upon hearing the chorus of cries, he fell from the jungle gym, joining the symphony while grabbing his left ankle.  Janine was on roller skates and following behind Egon in the skate park.  She had her earbuds in and didn’t hear the crying, so was surprised to come upon him in a heap on the ground.  She hadn’t been paying enough attention to maneuver around him, instead she tripped over him landing on her right hand.  Mr. and Mrs. Klutz took all the children to the ER for medical attention where they received the following diagnoses and care:

Egon-dislocated right patella, manipulation w/o anesthesia

Janine-contusion right hand, ice to injury

Peter-dislocated left shoulder, manipulation w/o anesthesia

Raymond-sprain left ankle, ace bandage

Little Dana-nondisplaced Colle’s fracture right wrist, splint (short arm, static)

 

After the ER care, the children went home with their parents to recuperate with all glad to be back home without further incident, at least for now!

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