Monday, June 28, 2021

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.