Breast Reconstruction


I’m doing a second stage breast reconstruction revision by removing the tissue expander and placement of a permanent implant. I got two codes pre-certified, 11970 (Replacement of tissue expander with permanent prosthesis) and 19380 (Revision of reconstructed breast). So I billed those two codes but the insurance company only paid one code, 11970. How can I appeal and also get paid for 19380?

Actually, the CPT code for removing a tissue expander and placing a permanent breast implant is reported using only 11970. CPT 19380 is not reported until the patient has undergone final reconstruction and now requires some type of revision.