Plastic surgery offers women various options to change the appearance of the breasts such as breast augmentation, breast reconstruction, breast reduction and breast lift. In 2021, there are major changes to CPT codes for breast procedures which include 15 revised codes and two deletions. Expert coders in medical billing companies are up-to-date on all the new changes and can help physicians select the correct codes based on these updates, which is important to avoid audits and get timely reimbursement.
- Breast Augmentation (Code 19325): Breast augmentation is a popular cosmetic surgical procedure that typically involves using FDA-approved implants to enhance the size and shape of a woman’s breasts. Breast enhancement may be also performed using fat from the patient’s own body. Fat grafting is often combined with implant surgery to enhance the results.
Updates for Breast Augmentation Coding:
- The language of the code descriptor for CPT 19325 has been simplified.
- CPT codes 15771 (Grafting of autologous fat harvested by liposuction technique) and 15772 (add-on code for autologous fat grafting to the trunk, breasts, extremities, or scalp for each additional 50cc of injectate) can be used to report fat grafting to the breast.
- A parenthetical has been added instructing users to report codes 15771 and 15772 when fat grafting is performed in conjunction with breast augmentation.
- Deleted: 19324 Mammaplasty, augmentation without prosthetic implant.
- Breast Reconstruction: Breast reconstruction involves rebuilding the breast(s) after mastectomy. This is usually done during or soon after mastectomy, but can also be performed many months or even years after the removal of the breast. Payers reimburse breast reconstruction after mastectomy performed for a medical reason as it is considered a relative safe and effective non-aesthetic procedure.
Applicable Codes with the Revised Descriptors
19328 Removal of intact mammary implant
19330 Removal of mammary implant material
19340 Insertion of breast implant on same day of mastectomy (i.e., immediate)
19342 Insertion or replacement of breast implant on a separate day from the mastectomy
19350 Nipple/areola reconstruction
19357 Tissue expander placement in breast reconstruction, including subsequent expansion (s)
19361 Breast reconstruction; with latissimus dorsi flap
19364 Breast reconstruction; with free flap (eg, TRAM, DIEP, SIEA, GAP flap)
19367 Breast reconstruction; with single-pedicled transverse rectus abdominismyocutaneous (tram) flap
19368 Breast reconstruction; with single-pedicled transverse rectus abdominismyocutaneous (tram) flap, requiring separate microvascular anastomosis(supercharging)
19369 Breast reconstruction; with bipedicled transverse rectus abdominis myocutaneous(tram) flap
19370 Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy,and/or partial capsulectomy
19371 Peri-implant capsulectomy, breast, complete, including removal of all intracapsularcontents
19380 Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction
19396 Preparation of moulage for custom breast implant
Deleted: 19366 Breast reconstruction with other technique
- 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. Both codes now have simplified descriptors and term “breast implant” is used in place of the term “breast prothesis”. The code selection depends whether the reconstruction was done immediately after the mastectomy or on a separate day from the mastectomy. There is a new parenthetical which states that 19342 and 19328 should not be reported in conjunction for removal of implant in the same breast. CPT code 11970 should be used for removal of tissue expander and replacement with a breast implant.
- Code 19357 is separately reportable if used in flap reconstruction, such as a lat dorsi flap (19361).
- Code 11971 has a change in the descriptor, where the term breast implant” has replaced the term “breast prothesis”. Code 11971 should not be reported in conjunction with 11970. If more-extensive capsular revisions are performed, use code 19370.
- Code 19370 – Revision of breast capsule. The important change for code 19370 is that in addition to being used for capsulotomies, it is also used to report revisions of peri-implant capsule including capsulotomy, capsulorraphy and/or partial capsulectomy. When placing a new implant, code 19342 can be separately reported. if the capsular work performed is significant, code 19370 can be reported with tissue expander exchange. Code 19370 cannot be reported in conjunction with CPT 19328 for removal and replacement of the same implant to access the capsule.
- Code 11971 – Removal of a tissue expander. The only change for code 11971 is that the word “prosthesis” has been replaced by “permanent implant”. For removal of a breast tissue expander and replacement with a breast implant, use code 11971.
- Mastopexy (Breast Lift) & Breast Reduction (Codes 19316 & 19318) – A mastopexy is a surgical procedure to lift the breasts to a more aesthetically pleasing position. A breast reduction is performed to reduce the size of overly large breasts. Code 19316 Mastopexy remains unchanged. In the descriptor code 19318, the word “reduction mammoplasty” has been changed to “breast reduction”.
The American Academy of Plastic Surgeons highlights the following important points about the 2021 CPT codes for breast reconstruction:
The above-listed codes are not all-inclusive. Plastic surgery practices also need to be knowledgeable about the important E/M coding updates that came into effect in 2021. Partnering with a medical billing company with expertise in plastic surgery medical billing and coding is the best way for practices to ensure that services provided are reported using the appropriate codes. The support of an experienced service provider can be very valuable as physicians and practices deal with the impacts of the novel coronavirus pandemic.