How To Use CPT Code 19371

CPT 19371 refers to a peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 19371 procedures.

1. What is CPT 19371?

CPT 19371 is a medical procedure code used to describe a peri-implant capsulectomy of the breast, which involves the complete removal of all intracapsular contents. This procedure is performed to address complications arising from a previous breast implant surgery, such as the formation of scar tissue around the implant.

2. 19371 CPT code description

The official description of CPT code 19371 is: “Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents.”

3. Procedure

The 19371 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. The provider incises the mastectomy or implant scar on the skin of the breast to locate the previously placed breast implant.
  3. The entire capsule of scar tissue surrounding the breast implant is excised.
  4. All intracapsular contents, such as tissues and fibrous scar, are removed along with the breast implant.
  5. The incision is closed with sutures.

4. Qualifying circumstances

Patients eligible to receive CPT code 19371 services are those who have previously undergone breast implant surgery and are experiencing complications due to the formation of scar tissue around the implant. These complications may include pain, discomfort, distortion of the breast shape, or implant rupture. The decision to perform a peri-implant capsulectomy is typically made after a thorough evaluation of the patient’s medical history, physical examination, and imaging studies, such as mammography or ultrasound.

5. When to use CPT code 19371

It is appropriate to bill the 19371 CPT code when a peri-implant capsulectomy is performed to address complications arising from a previous breast implant surgery, such as the formation of scar tissue around the implant. This code should be used only when the complete removal of all intracapsular contents is performed during the procedure.

6. Documentation requirements

To support a claim for CPT 19371, the following information needs to be documented:

  • Patient’s medical history, including previous breast implant surgery and any complications experienced.
  • Physical examination findings, such as breast shape, size, and symmetry.
  • Imaging studies, such as mammography or ultrasound, showing the presence of scar tissue around the implant.
  • Operative report detailing the peri-implant capsulectomy procedure, including the incision, excision of the scar tissue, removal of intracapsular contents, and closure of the incision.
  • Postoperative care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 19371, it is important to follow the appropriate guidelines and rules. Do not report CPT 19371 in conjunction with CPT 19328, CPT 19330, or CPT 19370 in the same breast. For removal and replacement with a new implant, use CPT 19342 instead. Ensure that all required documentation is complete and accurate to support the claim for this procedure.

8. Historical information

CPT 19371 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 “Periprosthetic capsulectomy, breast.”

9. Similar codes to CPT 19371

Five similar codes to CPT 19371 and how they differentiate are:

  1. CPT 19328: This code is used for the removal of a breast implant without a capsulectomy.
  2. CPT 19330: This code is used for the removal of a breast implant with a partial capsulectomy.
  3. CPT 19342: This code is used for the removal and replacement of a breast implant with a new implant.
  4. CPT 19370: This code is used for a peri-implant capsulectomy without the complete removal of all intracapsular contents.
  5. CPT 19380: This code is used for the revision of a previous breast reconstruction surgery, which may include a capsulectomy.

10. Examples

Here are 10 detailed examples of CPT code 19371 procedures:

  1. A patient with a history of breast augmentation experiences pain and distortion of the breast shape due to capsular contracture. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents.
  2. A patient with a ruptured breast implant undergoes a peri-implant capsulectomy with complete removal of all intracapsular contents, including the ruptured implant and silicone gel.
  3. A patient with a history of breast reconstruction with an implant develops a painful, hard capsule around the implant. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents.
  4. A patient with a history of breast augmentation presents with a double capsule, causing distortion of the breast shape. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents.
  5. A patient with a history of breast augmentation experiences pain and discomfort due to a late seroma around the implant. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents, including the seroma fluid.
  6. A patient with a history of breast augmentation presents with an implant malposition due to capsular contracture. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents to correct the implant position.
  7. A patient with a history of breast reconstruction with an implant develops a painful, hard capsule around the implant and a recurrent infection. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents, including the infected implant.
  8. A patient with a history of breast augmentation presents with a double capsule and a late seroma around the implant. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents, including the seroma fluid and the double capsule.
  9. A patient with a history of breast augmentation experiences pain and distortion of the breast shape due to capsular contracture and a ruptured implant. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents, including the ruptured implant and silicone gel.
  10. A patient with a history of breast reconstruction with an implant develops a painful, hard capsule around the implant and a recurrent infection. The provider performs a peri-implant capsulectomy with complete removal of all intracapsular contents, including the infected implant and any necrotic tissue.

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