Under the WHCRA, group health plans, insurance companies, and HMOs that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. This coverage includes reconstruction of the breast removed by mastectomy, reconstruction of the other breast to give a more balanced look, breast prostheses, and treatment of physical complications at all stages of the mastectomy, including lymphedema.
Your individual results will depend on factors, such as:
After breast reduction surgery, most patients are satisfied with their results. Some women, however, opt to have breast augmentation years later to restore lost volume, primarily due to weight loss and postpartum changes, as opposed to breast augmentation after birth. It is common for breast shape and overall aesthetic changes to be made at the ...
The description for 19380 was revised to give users more information regarding what is included in this code. This code is still to only be used for patients who have undergone previous mastectomy and completed reconstruction, who now require revision.
Encounter for breast reconstruction following mastectomy Z42. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z42. 1 became effective on October 1, 2021.
The American Academy of Plastic Surgeons highlights the following important points about the 2021 CPT codes for breast reconstruction: Codes 19340 and 19342 – Implant placement in breast reconstruction: The codes are used for placement of a new implant or replacement in mastectomy or reconstructed breast.
Excision of Bilateral Breast, Open Approach ICD-10-PCS 0HBV0ZZ is a specific/billable code that can be used to indicate a procedure.
Z90. 12 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z90. 12 became effective on October 1, 2021.
1 for Encounter for breast reconstruction following mastectomy is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Report code 19303, Mastectomy, simple, complete, for the mastectomy.
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.
CPT® Code 38900 - Other Procedures of the Hemic or Lymphatic System - Codify by AAPC. CPT. Surgical Procedures on the Hemic and Lymphatic Systems. Surgical Procedures on the Lymph Nodes and Lymphatic Channels.
ICD-10-PCS will be the official system of assigning codes to procedures associated with hospital utilization in the United States. ICD-10-PCS codes will support data collection, payment and electronic health records. ICD-10-PCS is a medical classification coding system for procedural codes.
The majority of PCS codes reported for the inpatient setting are found in the Medical and Surgical section of ICD-10-PCS. There are 31 root operations in this section. The entire list can be found with definitions and examples beginning on page 117 of the ICD-10-PCS Reference Manual.
Resection is similar to excision except it involves cutting out or off, without replacement, all of a body part. Resection includes all of a body part or any subdivision of a body part having its own body part value in ICD-10-PCS, while excision includes only a portion of a body part.
The code for this type of more involved mastectomy is 19305 .
Radical mastectomy. For female patients, partial mastectomy involves excising the mass from the breast, taking along with it a margin of healthy tissue. The title of the procedure will be important when determining the physician’s intention for the procedure.
The government passed the Women’s Health and Cancer Act (WHCRA) of 1998, enforcing coverage of reconstruction following mastectomies (if the plan allows for mastectomies). Check with your state’s Department of Insurance for your state’s coverage requirements.
During a subcutaneous mastectomy (19304), the surgeon dissects the breast away from the pectoral fascia and skin. As with the simple complete mastectomy, the surgeon removes all of the breast tissue, but spares the skin and pectoral fascia. The documentation should clearly illustrate the more complex nature of this procedure.
TRAM reconstruction involves using the skin and muscles from the abdomen to create a breast. The advantage to this technique is that the tissue remains attached to its blood supply. For a single pedicle flap, report 19367. If the surgeon uses two pedicles of the rectus abdominis, report 19369.
Three additional reconstruction procedures include transferring skin from another part of the patient’s body to the breast area. The latissimus dorsi flap (19361) describes a procedure during which muscle and skin are taken from the patient’s back and used to reconstruct a breast.
Breast implants are, perhaps, the most well-known reconstruction methods. These can be done during the same surgical session as the mastectomy (19340) or at a later time (19342). If reconstruction is delayed, the surgeon may perform a tissue expansion (19357).
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
08/1989 - Clarified coverage following a medically necessary mastectomy, and included applicable ICD-9-CM and HCPCS codes. Effective date NA. (TN 40)