Removal of Breast Implant with Capsulectomy

Removal of Breast Implant with Capsulectomy

October 17, 2019

Question:
My doctor specializes in breast reconstruction and has been asking me to bill 19328 (removal of intact breast implant) along with 19371 (capsulectomy) when he has to do a capsulectomy and remove the implant. It has come to my attention that this may be wrong and that 19328 is included in 19371. The CPT book is unclear and there is not a National Correct Coding Initiative (NCCI) edit between these two codes. So can I bill both?

Answer:
This is great example of where Medicare’s NCCI edits don’t reflect accurate coding. 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 19371 (capsulectomy) includes 19328 so both codes would never be reported for the same breast.

*This response is based on the best information available as of 10/17/19.

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