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

Deanna Upston, CPMA, CPC, COSC


Deanna is a consultant for The Haugen Consulting Group with over 20 years of health care industry experience.  Her introduction was through medical assisting, which she enjoyed for several years. Once she was established at a surgeon’s office, she started coding their surgical cases and discovered that was her favorite part of the day. Deanna has experience working on the professional fee side of coding, audit, education and compliance serving coders and physicians.  She has put together multiple education sessions for both provider and coder.  She also has experience working as an analyst in which she validated the integrity of editing logic during the implementation of claim scrubbing software.


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