CPT: 19318 Reduction mammoplasty ICD-9 Procedure: 85.31 Unilateral reduction mammoplasty 85.32 Bilateral reduction mammoplasty ICD-10 PCS 0HBT0ZZ Excision of Right Breast, Open Approach 0HBU0ZZ Excision of Left Breast, Open Approach 0HBV0ZZ Excision of Bilateral Breast, Open Approach Policy History: Developed May 9, 1988 Most recent history:
The inferior pedicle technique is a surgical technique performed for breast reduction (reduction mammoplasty). “Pedicle method” means the surgeon leaves an attached tissue graft (pedicle) with nerves and blood vessels that supply the breast.
However, a retrospective study of a single surgeon’s experience indicated that the pedicled Robertson mammoplasty, an inferior pedicle technique involving a curvilinear skin extension onto the pedicle, is a safe and effective means of breast reduction in patients who are obese and have extreme macromastia.
The use of such CPT codes as 12034 and 12035, 14001, 15830, 15836, 15839, 15876 through 15879, and 19350 associated with reshaping will be considered part of (bundled into) the primary reduction mammaplasty procedure. Indications of coverage must be met.
The inferior pedicle of breast technique (see image below) involves leaving a pedicle of tissue with the nipple in the superior portion of the pedicle, creating a wedge-shaped pedicle down to the chest wall. The pedicle should be an 8-cm base in smaller reductions and a 10-cm base in larger reductions.
Code 19316 Mastopexy remains unchanged. In the descriptor code 19318, the word “reduction mammoplasty” has been changed to “breast reduction”.
Added new ICD-10 codes: M40. 14, M40.
Sir: Bilateral reduction mammaplasty is an extremely common operation used to decrease the size of large breasts and relieve their many associated symptoms. Repeated bilateral reduction mammaplasty, in contrast, is an infrequently performed procedure.
Modifier 50Modifier 50 applies to bilateral procedures performed on both sides of the body during the same operative session. When a procedure is identified by the terminology as bilateral or unilateral, the 50 modifier is not reported.
A CPT Assistant newsletter states “A capsulectomy (CPT code 19371) involves removal of the capsule. The implant is also removed and may or may not be replaced.” Therefore, CPT 19370 (capsulotomy) is included in 19328 when performed to remove the implant.
ICD-10-PCS 0HSU0ZZ converts approximately to: 2015 ICD-9-CM Procedure 85.6 Mastopexy.
ICD-10 code N64. 4 for Mastodynia is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .
reduction mammaplastyIt recommends CPT code 19318 for reduction mammaplasty when breast tissue is removed for breast-size reduction and not for treatment or prevention of breast cancer. may be used to reflect reshaping of the nipple for cosmetic purposes.
Overview. Breast reduction surgery, also known as reduction mammaplasty, is a procedure used to remove excess fat, tissue and skin from the breasts. If you have large breasts, you might choose to have breast reduction surgery to ease discomfort or to achieve a breast size proportionate to your body.
Group 1CodeDescription19316MASTOPEXY19318BREAST REDUCTION
Medical Definition of mammaplasty : plastic surgery of the breast.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Reduction Mammaplasty.
The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the related determination.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
It states that 611.1 billed with secondary diagnosis V58.42 is to be used to indicate a mammoplasty to reduce the size of a normal breast to bring it into symmetry with a breast reconstructed after cancer surgery.
Medicare denied 19318-LT, the left breast reduction which was needed to make the breasts symmetrical. Diagnoses for left breast are: Macromastia & Breast Asymmetry. Procedure: Left breast reduction with a Weiss inferior pedicle pattern for symmetry. According to The Women's Health and Cancer Rights Act (WHCRA), ...
The inferior pedicle technique is a surgical technique performed for breast reduction ( reduction mammoplasty ). “Pedicle method” means the surgeon leaves an attached tissue graft (pedicle) with nerves and blood vessels that supply the breast. A pedicle can be superior, lateral, medial, inferior, or central. With the inferior pedicle technique, the ...
Patients who undergo reduction mammoplasty tend to be the most satisfied patients treated by plastic surgeons. It can be performed at any age following puberty.
Although breast MRI has superior sensitivity in identifying new unknown malignancies, it carries a significant false positive risk when compared to mammogram and ultrasound. Incidental lesions are seen on 15% of breast MRI’s and increase with younger age The percentage of incidental lesions that turn out to be malignant varies from 3% to 20% depending on the individual population. Cancer is identified by breast MRI in only 0.7% of those with “inconclusive mammographic lesions
* Breast MRI should not be used to determine biopsy recommendations for suspicious or indeterminate lesion (s) that can be readily biopsied, either using imaging guidance or physical exam, such as palpable masses and microcalcifications.
* The use of CAD with breast MRI is currently considered investigational, experimental, and/or unproven.#N#o 3D rendering codes (CPT®76376 or CPT®76377) should not be used in conjunction with code 0159T
1. Removal of breast implants that were placed for reconstruction after mastectomy, injury, congenital asymmetry, or augmentation mammoplasty is a covered benefit for the following indications: a. Implants with recurrent infection.
Indications. In general, a patient is considered a candidate for breast reduction if the size and weight of her breasts cause her significant neck and shoulder pain. Criteria have been established by some insurance companies as to the amount to be removed from each breast according to a patient's height and weight.
Small reductions in which the breasts are not reduced by at least 2 cup sizes are not usually covered by insurance and would likely be considered a breast lift or mastopexy. Breast shape varies among patients, but knowing and understanding the anatomy of the breast (see image below) ensures safe surgical planning.
Women have successfully breastfed following reduction mammoplasty, but patients should be warned that this may not be possible .
However, a retrospective study of a single surgeon’s experience indicated that the pedicled Robertson mammoplasty, an inferior pedicle technique involving a curvilinear skin extension onto the pedicle, is a safe and effective means of breast reduction in patients who are obese and have extreme macromastia.
For more information about the relevant anatomy, see Breast Anatomy. The only real contraindication to breast reduction surgery is if the patient is not medically able to undergo the surgery. Scars are the main risk that should be discussed with the patient.
In general, if loss of nipple sensation does occur, it usually improves over the course of the year or so following surgery. A prospective, nonrandomized study by Muslu et al indicated that inferior pedicle breast reduction is a safe technique with regard to sensory changes.