Reporting 19342 and 11970

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September 18, 2014

Question:

Over the past 15 years I have taken numerous courses taught by KZA, as has my staff. We have found you, your colleagues at KZA, and the courses all to be wonderful and very beneficial.

I was wondering if you could help me with a question I have. The last course I took with you had an emphasis on breast reconstruction coding and that was great. When a patient has an exchange of a tissue expander for a permanent implant and at the same time either a capsulectomy or a capsulotomy, I have been using 19342 instead of the 11970. I’ve thought about billing both codes – 19342 and 11970. What do you think? Any suggestions you may have will be greatly appreciated.

Answer:

Good question. The AMA’s CPT Assistant from August 2005 says: “If a temporary tissue expander has been used, it is removed after the skin has stretched sufficiently and replaced with a permanent breast prosthesis during a second operation. This procedure is generally coded 11970, Replacement of tissue expander with permanent prosthesis. Code 11970 is global and includes removal of the temporary expander, which is not to be reported separately. In certain instances, considerable capsular adjustments are necessary to allow proper placement of the prosthesis within the fibrous capsule that has formed around the expander, and with appropriate documentation in the operative report, code 19342 is sometimes used instead of 11970.” Therefore, you would never report 11970 with 19342 for a procedure on the same breast.