How To Use cpt 11960

cpt 11960 describes the insertion of tissue expanders for tissue defects in areas other than the breast, including subsequent expansion. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of cpt 11960.

1. What is cpt 11960?

cpt 11960 is a code used to describe the insertion of tissue expanders for tissue defects in areas other than the breast. This procedure involves the placement of one or more implants under the patient’s skin to expand the tissues. The expanders are typically made of silicone and are used to gradually stretch and expand the tissue beneath the deep fascia, allowing for future surgical procedures. cpt 11960 also includes subsequent expansion of the tissue expander using a saline solution.

2. Official Description

The official description of cpt 11960 is: ‘Insertion of tissue expander(s) for other than breast, including subsequent expansion.’

3. Procedure

The procedure for cpt 11960 involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the area of the patient’s body that needs treatment, excluding the breast.
3. A temporary implant, typically silicone, is inserted under the patient’s skin.
4. The provider closes the incision after placing the implant.
5. The provider increases the volume of the expander by injecting a saline solution.
6. The skin expands, and tissue grows within a few days or over time, allowing for future surgical procedures.

4. Qualifying circumstances

cpt 11960 is used for patients who require the insertion of tissue expanders for tissue defects in areas other than the breast. This procedure is typically performed when the existing skin or tissue is insufficient to cover the defect, such as in cases of extensive burns. The patient must meet the criteria for the procedure, and the provider must determine that the use of tissue expanders is necessary for the patient’s treatment.

5. When to use cpt code 11960

cpt 11960 should be used when a provider performs the insertion of tissue expanders for tissue defects in areas other than the breast, including subsequent expansion. This code should not be reported in conjunction with codes 11971, 13160, 29848, 64702-64726. For breast reconstruction, a different code, 19357, should be used.

6. Documentation requirements

To support a claim for cpt 11960, the provider must document the following information:

• Patient’s diagnosis and the need for tissue expansion
• Details of the procedure, including the location of the tissue defect
• Date of the procedure
• Start and end time of the procedure
• Details of subsequent expansion, including the volume of saline injected
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for cpt 11960, ensure that the procedure meets the criteria for the code. Do not report cpt 11960 in conjunction with codes 11971, 13160, 29848, 64702-64726. For replacement of a tissue expander with placement of a permanent implant, use code 11970. For removal of a tissue expander without placement of an implant, use code 11971.

8. Historical information

cpt 11960 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to cpt 11960

Five similar codes to cpt 11960 include:

• cpt 11961: This code is used for the replacement of a tissue expander with placement of a permanent implant.
• cpt 11970: This code is used for the removal of a tissue expander without placement of an implant.
• cpt 13160: This code is used for the repair of complex forehead and scalp defects.
• cpt 29848: This code is used for the repair of complex eyelid defects.
• cpt 64702-64726: These codes are used for the repair of complex facial defects.

9. Examples

1. A patient with extensive burns requiring tissue expansion for future grafting procedures.
2. A patient with a large tissue defect on their leg due to trauma, requiring the insertion of a tissue expander for future reconstruction.
3. A patient with a congenital defect in their abdominal wall, requiring the insertion of a tissue expander for future repair.
4. A patient with a significant scar contracture, requiring tissue expansion to release the contracture and improve function.
5. A patient with a large skin defect following tumor removal, requiring tissue expansion for future reconstruction.
6. A patient with a complex wound on their back, requiring the insertion of a tissue expander for future closure.
7. A patient with a tissue defect on their arm due to infection, requiring the insertion of a tissue expander for future reconstruction.
8. A patient with a significant soft tissue defect on their face, requiring tissue expansion for future cosmetic reconstruction.
9. A patient with a large defect on their scalp, requiring the insertion of a tissue expander for future hair restoration.
10. A patient with a tissue defect on their buttocks, requiring tissue expansion for future reconstruction.