Surgical reconstruction of the breast requires specific coding skills and knowledge of the relevant coding systems. The following are some coding guidelines for surgical reconstruction of the breast:
- Mastectomy: Mastectomy is the surgical removal of all or part of a breast. The code for a simple mastectomy is CPT code 19303, while a radical mastectomy is coded as CPT code 19307. The code for a partial mastectomy with axillary lymph node dissection is CPT code 19301.
- Breast Reconstruction: Breast reconstruction is a surgical procedure to restore the shape and appearance of the breast after a mastectomy. The code for breast reconstruction is CPT code 19340. The code for implantation of a breast prosthesis following a mastectomy is CPT code 19342.
- Nipple Reconstruction: Nipple reconstruction is a surgical procedure to reconstruct the nipple after breast reconstruction. The code for nipple reconstruction is CPT code 19350.
- Tissue Expansion: Tissue expansion is a surgical procedure that stretches the skin to create a pocket for a breast implant. The code for tissue expansion is CPT code 19357.
- Flap Procedures: Flap procedures are surgical techniques that use tissue from other parts of the body to reconstruct the breast. The code for a pedicle TRAM flap is CPT code 19364, while the code for a free TRAM flap is CPT code 19366. The code for a DIEP flap is CPT code 19367.
- Revision Procedures: Revision procedures are surgical procedures performed to correct complications or improve the results of a previous breast reconstruction surgery. The code for revision of breast reconstruction is CPT code 19380.
It is essential to ensure that the coding is accurate and specific, as errors can result in denied claims and delay in reimbursement. Therefore, it is crucial to have a thorough understanding of the coding guidelines and keep up-to-date with the changes in the coding systems. It is also important to document the details of the procedure accurately in the medical record to support the codes assigned.