How To Use CPT Code 19342

CPT 19342 refers to the insertion or replacement of a breast implant on a separate day from mastectomy. 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 19342 procedures.

1. What is CPT 19342?

CPT 19342 is a medical billing code used to describe the surgical procedure of inserting or replacing a breast implant on a separate day from a mastectomy. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 19342 CPT code description

The official description of CPT code 19342 is: “Insertion or replacement of breast implant on separate day from mastectomy.”

3. Procedure

The procedure for CPT 19342 involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the previous incision site from a prior mastectomy.
3. A pocket (space in the tissues) is created, and the tissues and skin are rearranged.
4. An implant is placed in the pocket, or an existing implant is removed and replaced with a new one.
5. The incision is closed with sutures.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 19342 services are those who have undergone a mastectomy and require the insertion or replacement of a breast implant on a separate day from the mastectomy. This may be due to various reasons, such as the need for additional healing time or the patient’s preference for a delayed reconstruction. The decision to perform this procedure is typically made in consultation with the patient and their healthcare provider, taking into consideration the patient’s overall health, medical history, and personal preferences.

5. When to use CPT code 19342

CPT code 19342 should be used when billing for the insertion or replacement of a breast implant on a separate day from a mastectomy. This code is appropriate for unilateral services, meaning it is performed on one breast. If the procedure is performed bilaterally, follow payer reporting guidelines for billing a bilateral service. It is important to note that CPT 19342 should not be reported in conjunction with CPT 19328 for the removal of an implant in the same breast.

6. Documentation requirements

To support a claim for CPT 19342, the following information should be documented:

• Patient’s medical history, including the date of the mastectomy
• Reason for the insertion or replacement of the breast implant
• Details of the surgical procedure, including the type and size of the implant used
• Postoperative care instructions and follow-up appointments
• Any complications or adverse events related to the procedure

7. Billing guidelines

When billing for CPT code 19342, it is essential 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, do not report CPT 19342 in conjunction with CPT 19328 for the removal of an implant in the same breast. For the removal of a tissue expander and replacement with a breast implant, use CPT 11970. For the supply of the implant, use CPT 99070.

8. Historical information

CPT 19342 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 “Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction.”

9. Similar codes to CPT 19342

Five similar codes to CPT 19342 and how they differentiate are:

• CPT 19340: This code is used for the immediate insertion of a breast implant following a mastectomy, rather than on a separate day.
• CPT 19328: This code is for the removal of a breast implant without replacement.
• CPT 11970: This code is used for the removal of a tissue expander and replacement with a breast implant.
• CPT 19325: This code is for breast augmentation with the insertion of an implant.
• CPT 19318: This code is for breast reduction surgery, which is a different procedure than implant insertion or replacement.

10. Examples

Here are 10 detailed examples of CPT code 19342 procedures:

1. A patient who had a mastectomy six months ago and now requires the insertion of a breast implant for reconstruction.
2. A patient who had a mastectomy and tissue expander placement, now requiring the removal of the tissue expander and insertion of a breast implant.
3. A patient who had a mastectomy and immediate breast implant placement, but the implant has since ruptured and requires replacement.
4. A patient who had a mastectomy and breast implant placement, but the implant has become displaced and requires repositioning and replacement.
5. A patient who had a mastectomy and breast implant placement, but the implant has developed a severe capsular contracture and requires replacement.
6. A patient who had a mastectomy and breast implant placement, but the implant has become infected and requires removal and replacement after the infection has been treated.
7. A patient who had a mastectomy and breast implant placement, but the implant has developed a visible rippling effect and requires replacement with a different type of implant.
8. A patient who had a mastectomy and breast implant placement, but the implant has caused significant pain and discomfort and requires replacement with a smaller implant.
9. A patient who had a mastectomy and breast implant placement, but the implant has caused an unsatisfactory cosmetic result and requires replacement with a different size or shape of implant.
10. A patient who had a mastectomy and breast implant placement, but the implant has caused an asymmetry with the contralateral breast and requires replacement with a more suitable implant to achieve symmetry.