How To Use CPT Code 19340

CPT 19340 refers to the immediate insertion of a breast implant following a mastectomy. This article will cover the code description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 19340 procedures.

1. What is CPT 19340?

CPT 19340 is a medical billing code used to describe the immediate insertion of a breast implant following a mastectomy. This code is used by medical coders and billers to accurately document and bill for this specific procedure. The code represents a unilateral service, meaning it is performed on one breast. Bilateral services should follow payer reporting guidelines.

2. 19340 CPT code description

The official description of CPT code 19340 is: “Insertion of breast implant on the same day of mastectomy (i.e., immediate)”.

3. Procedure

The 19340 procedure involves the following steps:

1. The patient undergoes a mastectomy (breast excision).
2. On the same day, the provider creates a pocket (space in the tissue) for the breast implant.
3. The breast implant is inserted into the pocket.
4. The provider closes the pocket over the implant and completes the procedure.

4. Qualifying circumstances

Patients eligible to receive CPT code 19340 services are those who have undergone a mastectomy and require immediate breast reconstruction. This may include patients with breast cancer, those with a high risk of developing breast cancer, or those who have experienced significant breast tissue loss due to trauma or infection. The decision to perform immediate breast reconstruction is typically based on the patient’s overall health, the stage of their cancer, and their personal preferences.

5. When to use CPT code 19340

It is appropriate to bill the 19340 CPT code when a patient undergoes a mastectomy and requires immediate breast reconstruction with the insertion of a breast implant on the same day. This code should not be used for breast implant insertion or replacement on a separate day from the mastectomy, which is represented by CPT code 19342.

6. Documentation requirements

To support a claim for CPT 19340, the following information should be documented:

• Patient’s medical history and reason for the mastectomy.
• Details of the mastectomy procedure, including the type of mastectomy performed and any complications encountered.
• Description of the breast implant insertion, including the type and size of the implant, the surgical technique used, and any complications encountered.
• Postoperative care instructions and follow-up appointments.
• Any relevant diagnostic tests, imaging studies, or pathology reports.

7. Billing guidelines

When billing for CPT code 19340, it is important to follow payer-specific guidelines and requirements for reimbursement. Many health insurance policies cover reconstructive surgery following mastectomy, although coverage may vary. Check with the payer to determine their requirements for reimbursement. Additionally, ensure that the documentation supports the use of CPT 19340 and accurately reflects the services provided.

8. Historical information

CPT 19340 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2021, with the previous descriptor being “Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction”.

9. Similar codes to CPT 19340

Five similar codes to CPT 19340 and how they differentiate are:

1. CPT 19342: This code is used for the insertion or replacement of a breast implant on a separate day from the mastectomy.
2. CPT 19357: This code is used for breast reconstruction with tissue expander placement, which involves a different method of reconstruction than CPT 19340.
3. CPT 19361: This code is used for breast reconstruction with a latissimus dorsi flap, which involves using a patient’s own tissue rather than an implant for reconstruction.
4. CPT 19364: This code is used for breast reconstruction with a free flap, which involves transferring tissue from another part of the body to the breast area.
5. CPT 19366: This code is used for breast reconstruction with a pedicled TRAM (transverse rectus abdominis myocutaneous) flap, which involves using abdominal tissue for reconstruction.

10. Examples

Here are 10 detailed examples of CPT code 19340 procedures:

1. A patient with breast cancer undergoes a mastectomy and immediate breast implant insertion on the same day.
2. A patient with a high risk of developing breast cancer undergoes a prophylactic mastectomy and immediate breast implant insertion.
3. A patient who has experienced significant breast tissue loss due to trauma undergoes a mastectomy and immediate breast implant insertion.
4. A patient with breast cancer undergoes a nipple-sparing mastectomy and immediate breast implant insertion.
5. A patient with breast cancer undergoes a skin-sparing mastectomy and immediate breast implant insertion.
6. A patient with breast cancer undergoes a modified radical mastectomy and immediate breast implant insertion.
7. A patient with breast cancer undergoes a total mastectomy and immediate breast implant insertion.
8. A patient with breast cancer undergoes a partial mastectomy and immediate breast implant insertion.
9. A patient with breast cancer undergoes a lumpectomy and immediate breast implant insertion.
10. A patient with breast cancer undergoes a mastectomy with sentinel lymph node biopsy and immediate breast implant insertion.