subject: CPT assistant: Do away with your breast implant coding woes [print this page] CPT assistant: Do away with your breast implant coding woes
Your general surgeon may carry out breast reconstruction post cancer, infection, trauma, or burns or for that matter strictly for cosmetic reasons. See to it that you capture right implant pay, when that is part of the surgical scheme by following our experts' tips:
Tip 1: Prosthesis' purpose drives coding
Normally, breast implants serve two purpose: cosmetic breast enhancement or breast reconstruction following a disfiguring event like mastectomy for cancer or a traumatic injury.
CPT segregates implant codes based on the function; as such that's the first distinction you need to make when choosing the right code.
Tip 3: Timing is key 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.
Tip 4: Timing is really important 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.
Tip 5: Expander covers fill-ups
When your surgeon carries out a reconstruction using a tissue expander, you will go for 19357. Contrary to implant insertion coding, you will use the same expander code irrespective of whether the procedure is immediate' or delayed' following a mastectomy.
Tip 6: Double up with modifier 50
The breast implant and reconstruction codes are unilateral they talk about the service for one breast. Some payers want you to append modifier LT (left side) or RT (right side) to the procedure code. If the surgeon carries out any of these procedures on both breasts, you should go for modifier 50 (bilateral procedure) to indicate that.
If you are not well-versed with the right CPT codes, you could be in for denials. So the best way to break the denial cycle is by signing up for a one-stop medical coding guide. When you sign up for one, you will get CPT Assistant 1990-2009 articles and RQs linked to every applicable CPT code. So with this, you can get information straight from the AMA connected to your super-fast CPT code searches all without leaving this one-stop guide.
