How To Use CPT Code 19357

CPT 19357 refers to the placement of a tissue expander in breast reconstruction, including subsequent expansions. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 19357 procedures.

1. What is CPT 19357?

CPT 19357 is a medical procedure code used to describe the placement of a tissue expander in breast reconstruction, including subsequent expansions. This procedure is typically performed following a mastectomy or to correct congenital defects, with the goal of increasing the size and volume of the breast to make space for a permanent implant.

2. 19357 CPT code description

The official description of CPT code 19357 is: “Tissue expander placement in breast reconstruction, including subsequent expansion(s)”.

3. Procedure

The 19357 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the chest wall, mainly over the pectoralis major muscles, creating a pocket.
3. The tissue expander is placed into the pocket of the muscle.
4. A substance, such as saline, is injected into the expander to initiate the expansion process.
5. The incision site is closed.
6. Over a period of weeks or months, the provider injects more of the substance to create additional tissue expansion. This code includes any subsequent expansion the provider performs.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 19357 services include those who have undergone a mastectomy, those with congenital breast defects, or those who have experienced a loss of breast tissue due to trauma or other medical conditions. The procedure is performed to create space for a permanent implant, either immediately after mastectomy or at a later time.

5. When to use CPT code 19357

It is appropriate to bill the 19357 CPT code when a provider performs a tissue expander placement in breast reconstruction, including subsequent expansions. This code can be used for both immediate and delayed breast reconstruction following a mastectomy or to correct congenital defects or loss of tissue.

6. Documentation requirements

To support a claim for CPT 19357, the following information should be documented:

• Patient’s medical history, including the reason for breast reconstruction (e.g., mastectomy, congenital defect, or loss of tissue).
• Details of the procedure, including the type of tissue expander used, the substance injected, and the number of expansions performed.
• Postoperative care instructions and follow-up appointments for subsequent expansions.
• Any complications or adverse reactions experienced by the patient during or after the procedure.

7. Billing guidelines

When billing for CPT code 19357, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 19357 include:

• Report 19357 whether the provider inserts the expander immediately after mastectomy or post mastectomy.
• A breast expander may be temporary. Later placement of a permanent implant is reportable using CPT 11970. Report CPT 11971 when the provider removes the temporary expander without replacing it with an implant.

8. Historical information

CPT 19357 was added to the Current Procedural Terminology system on January 1, 1992. The code was changed on January 1, 2021, with the previous descriptor being “Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion”.

9. Similar codes to CPT 19357

Five similar codes to CPT 19357 and how they differentiate from CPT 19357 are:

1. CPT 19340: This code is used for immediate insertion of a breast prosthesis following a mastectomy, without the use of a tissue expander.
2. CPT 19342: This code is used for delayed insertion of a breast prosthesis following a mastectomy, without the use of a tissue expander.
3. CPT 19350: This code is used for nipple/areola reconstruction, which may be performed in conjunction with breast reconstruction using a tissue expander.
4. CPT 11970: This code is used for the replacement of a temporary tissue expander with a permanent breast implant.
5. CPT 11971: This code is used for the removal of a temporary tissue expander without replacing it with a permanent implant.

10. Examples

Here are 10 detailed examples of CPT code 19357 procedures:

1. A patient undergoes a mastectomy and has a tissue expander placed immediately after the surgery, with subsequent expansions performed over several weeks.
2. A patient with a congenital breast defect has a tissue expander placed to create space for a permanent implant, with expansions performed over several months.
3. A patient who has experienced loss of breast tissue due to trauma undergoes a tissue expander placement, with subsequent expansions performed over a period of time.
4. A patient undergoes a mastectomy and has a tissue expander placed several months later, with expansions performed over several weeks.
5. A patient with a history of breast cancer undergoes a mastectomy and has a tissue expander placed for breast reconstruction, with subsequent expansions performed over a period of time.
6. A patient with a congenital breast defect undergoes a tissue expander placement and subsequent expansions, followed by the placement of a permanent implant.
7. A patient who has experienced loss of breast tissue due to radiation therapy undergoes a tissue expander placement, with subsequent expansions performed over several months.
8. A patient undergoes a mastectomy and has a tissue expander placed, with subsequent expansions performed over several weeks, followed by the placement of a permanent implant.
9. A patient with a history of breast cancer undergoes a mastectomy and has a tissue expander placed for breast reconstruction, with subsequent expansions performed over a period of time, followed by the placement of a permanent implant.
10. A patient who has experienced loss of breast tissue due to a medical condition undergoes a tissue expander placement, with subsequent expansions performed over several months, followed by the placement of a permanent implant.