Placement of Mesh in Breast Reconstruction Procedures

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Question:

When performing a TRAM flap single pedicle or other types of breast reconstruction procedures where I close the donor site with mesh, does the breast reconstruction code such as 19367 include the mesh placement for donor site or is it separately billable with code 49568? I was told by a colleague that the mesh code is separately reportable but I just wanted to check with you to be sure before I billed it. Thank you!

Answer:

Actually, according to CPT rules, 49568 can only be billed with a hernia repair code so it is not appropriate to report the code with a breast reconstruction procedure code such as 19367. Because 19367 says “including closure of donor site” then placing the mesh is part of the closure and not separately reported. It would not be accurate to report 15777 for mesh placement since it is not a “biologic” as required by the CPT code.