How To Use CPT Code 19316

CPT 19316 refers to the mastopexy procedure, also known as a breast lift, which involves removing excess skin and tightening surrounding tissue. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 19316.

1. What is CPT 19316?

CPT 19316 is a medical billing code used to describe the mastopexy procedure, commonly known as a breast lift. This surgical procedure is performed to reshape and lift sagging breasts by removing excess skin and tightening the surrounding tissue. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 19316 CPT code description

The official description of CPT code 19316 is: “Mastopexy.”

3. Procedure

The CPT 19316 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. The provider selects the appropriate incision pattern and technique based on the patient’s individual factors, such as breast size and shape, position of the areola, and skin quality.
  3. Examples of incision patterns include circumareolar mastopexy, triangle resection, and vertical mastopexy.
  4. The provider may perform steps such as thinning, lifting, and reshaping tissues; repositioning the nipple and areola; and placing deep stitches to achieve the desired effect.
  5. The incisions are closed, further tightening the skin.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 19316 services typically have sagging breasts due to factors such as aging, pregnancy, breastfeeding, weight fluctuations, or heredity. The procedure is generally considered for patients who are in good overall health, have realistic expectations, and are not planning future pregnancies or significant weight loss, as these factors may affect the results of the mastopexy.

5. When to use CPT code 19316

It is appropriate to bill the 19316 CPT code when a provider performs a mastopexy procedure to lift and reshape sagging breasts. The code should be used to accurately document and bill for this specific procedure, ensuring proper reimbursement for the provider’s services.

6. Documentation requirements

To support a claim for CPT 19316, the following information should be documented:

  • Patient’s medical history, including factors contributing to breast sagging
  • Physical examination findings, including breast size, shape, and degree of sagging
  • Preoperative photographs
  • Details of the surgical procedure, including incision patterns, techniques used, and any complications encountered
  • Postoperative care instructions and follow-up appointments

7. Billing guidelines

When billing for CPT code 19316, it is important to follow payer-specific guidelines and requirements regarding coverage and medical necessity. Some payers may consider this code to be unilateral, allowing for additional reimbursement when a bilateral procedure is performed and reported. It is essential to review payer policies and ensure accurate coding based on the specifics of the operative report.

8. Historical information

CPT 19316 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 19316

Five similar codes to CPT 19316 and how they differ are:

  • CPT 19318: Breast reduction, which involves removing excess breast tissue and skin to reduce breast size.
  • CPT 19324: Breast augmentation, which involves the insertion of breast implants to increase breast size.
  • CPT 19325: Breast augmentation with a mastopexy, which combines breast lift and augmentation procedures.
  • CPT 19328: Removal of breast implants, which involves the surgical removal of previously placed breast implants.
  • CPT 19330: Removal of breast tissue for gynecomastia, which involves the surgical removal of excess male breast tissue.

10. Examples

Here are 10 detailed examples of CPT code 19316 procedures:

  1. A 40-year-old woman with sagging breasts due to aging and pregnancy undergoes a mastopexy using a vertical incision pattern.
  2. A 35-year-old woman with significant breast sagging following significant weight loss undergoes a mastopexy with a circumareolar incision pattern.
  3. A 45-year-old woman with a history of breastfeeding and sagging breasts undergoes a mastopexy using a triangle resection technique.
  4. A 50-year-old woman with hereditary breast sagging undergoes a mastopexy with a combination of incision patterns to achieve the desired lift and shape.
  5. A 38-year-old woman with sagging breasts due to hormonal changes undergoes a mastopexy using a vertical incision pattern and deep stitches for support.
  6. A 42-year-old woman with sagging breasts and asymmetry undergoes a mastopexy with a circumareolar incision pattern on one breast and a vertical incision pattern on the other to achieve symmetry.
  7. A 48-year-old woman with sagging breasts and a history of smoking undergoes a mastopexy using a triangle resection technique and additional skin tightening measures.
  8. A 36-year-old woman with sagging breasts due to pregnancy and breastfeeding undergoes a mastopexy with a vertical incision pattern and nipple repositioning.
  9. A 46-year-old woman with sagging breasts and a history of weight fluctuations undergoes a mastopexy using a combination of incision patterns and tissue reshaping techniques.
  10. A 52-year-old woman with sagging breasts and a history of breast cancer undergoes a mastopexy using a circumareolar incision pattern and additional supportive measures.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *