Breast reconstruction is a surgical procedure aimed at restoring the shape and appearance of the breast after mastectomy or lumpectomy. This article provides a detailed overview of the CPT codes related to breast reconstruction, from the perspective of both patients and plastic surgeons. From the initial consultation to the post-operative follow-up, we will explore the various aspects involved in breast reconstruction and the corresponding CPT codes.
1. Initial Consultation (CPT codes: 99201-99205)
The first step in breast reconstruction is the initial consultation with a plastic surgeon. During this visit, the surgeon evaluates the patient's medical history, performs a physical examination, and discusses the available options. The CPT codes for this stage range from 99201 to 99205, with the specific code chosen based on the complexity of the patient's case.
2. Pre-operative Planning (CPT code: 19318)
Prior to surgery, the plastic surgeon creates a detailed plan for the breast reconstruction procedure. This includes determining the appropriate technique, considering the patient's preferences, and coordinating with other healthcare professionals. The CPT code for pre-operative planning is 19318.
3. Tissue Expanders and Implant Placement (CPT codes: 19340-19342)
In some cases, tissue expanders are used to stretch the remaining skin and create a pocket for the implant. The CPT codes 19340 and 19342 represent the insertion and subsequent filling of tissue expanders, respectively. Once the desired expansion is achieved, the expanders are exchanged for breast implants, which are assigned the CPT code 19342.
4. Autologous Tissue Reconstruction (CPT codes: 19364-19366)
Autologous tissue reconstruction involves the use of the patient's own tissue, usually from the abdomen or back, to reconstruct the breast. Different CPT codes are assigned based on the complexity and extent of the procedure. For example, CPT code 19364 is used for single-pedicle TRAM flap reconstruction, while CPT codes 19365 and 19366 represent free flap reconstruction.
5. Nipple and Areola Reconstruction (CPT code: 19370)
Once the breast mound is reconstructed, the surgeon can proceed with nipple and areola reconstruction. This involves creating a nipple mound and tattooing the areola to achieve a natural appearance. The CPT code for nipple and areola reconstruction is 19370.
6. Symmetry Procedures (CPT codes: 19380-19384)
In some cases, additional procedures may be required to achieve symmetry between the reconstructed breast and the unaffected breast. These procedures may involve reduction, augmentation, or lifting of the unaffected breast. The corresponding CPT codes for symmetry procedures range from 19380 to 19384, depending on the complexity and extent of the procedure.
7. Complication Management (CPT codes: 20100-20938)
Complications can arise during or after breast reconstruction surgery, requiring additional procedures for management. The CPT codes for complication management, such as seroma drainage or revision surgery, fall within the range of 20100 to 20938, depending on the specific procedure performed.
8. Post-operative Follow-up (CPT codes: 99024, 99024)
Regular follow-up visits are essential to monitor the patient's progress and address any concerns or complications. CPT code 99024 is used specifically for post-operative follow-up visits related to breast reconstruction.
Conclusion
Breast reconstruction is a multidimensional process involving various stages and procedures. Familiarity with the corresponding CPT codes is crucial for accurate documentation and billing for these services. Both patients and plastic surgeons can benefit from a comprehensive understanding of the CPT codes associated with breast reconstruction, ensuring optimal care and reimbursement.
References:
1. American Medical Association. (2021). Current Procedural Terminology (CPT) 2021. Chicago, IL: American Medical Association.
2. British Association of Plastic, Reconstructive and Aesthetic Surgeons. (2021). Aesthetic and Reconstructive Breast Surgery Guidelines. Retrieved from: https://publishing.rcseng.ac.uk/doi/book/10.1308/9781911510837
3. Canadian Society of Plastic Surgeons. (2021). Practice Guidelines - Breast Reconstruction. Retrieved from: https://plasticsurgery.ca/docs/default-source/clinical-practice-guidelines/bsp-bst-rs--guidelines/cps-cir-hg-brss-eng-feb2021.pdf
