Q: May code 19380 (revision of reconstructed breast) be reported with code 11970 (replacement of tissue expander with permanent implant)?
A: Yes, it would be appropriate to report code 19380 If extensive capsule and extensive soft tissue work is performed (eg, not simply revising the scar or removing a minor amount of skin), report code 19380 instead of code 19370, because the work of code 19370 is included in code 19380
Q: We often have patients that need a mastopexy or breast augmentation on the contralateral breast after a mastectomy and reconstruction for breast cancer due to significant asymmetry. Does insurance typically cover that?
A: This is a great question, I did touch on this at the beginning of the presentation. This should be a covered scenario for most patients, I think the key is getting pre-authorization and using the correct diagnosis code, N65.1, for asymmetry between a reconstructed breast and the native breast.
Q; If a patient comes back to the clinic outside of the global of a nipple reconstruction, for additional tattooing, is that a billable service?
A: Technically yes, if they are outside of the global period, but make sure to check payor policy, as this is often not a covered service.
Deanna Upston, CPMA, CPC, COSC