How To Use CPT Code 19380
CPT 19380 refers to the revision of a reconstructed breast, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.
1. What is CPT 19380?
CPT 19380 is a medical billing code used to describe the revision of a reconstructed breast. This procedure is performed to improve the cosmetic appearance or address complications in patients who have undergone breast reconstruction surgery. The code is specific to significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction, or significant capsular revision combined with soft tissue excision in implant-based reconstruction.
2. 19380 CPT code description
The official description of CPT code 19380 is: “Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)”.
The 19380 CPT code procedure involves the following steps:
- The patient is appropriately prepped and anesthetized.
- The provider removes excess amounts of tissues, skin, and fats to reshape the breast to look like the contralateral (other) breast.
- If necessary, the provider performs significant revision of the breast–implant capsule (scar tissue) along with soft tissue excision.
- Drains are placed to prevent fluid accumulation.
- The incision site is closed with sutures or staples.
4. Qualifying circumstances
Patients eligible to receive CPT code 19380 services are those who have undergone breast reconstruction surgery and are experiencing complications or unsatisfactory cosmetic results. These complications may include:
- Asymmetry between the reconstructed and contralateral breast
- Implant malposition or rupture
- Excessive scar tissue formation (capsular contracture)
- Flap necrosis or failure in autologous reconstruction
- Patient dissatisfaction with the overall appearance of the reconstructed breast
5. When to use CPT code 19380
It is appropriate to bill the 19380 CPT code when a patient requires significant revision of a reconstructed breast due to complications or unsatisfactory cosmetic results. The procedure should be performed by a qualified healthcare provider with experience in breast reconstruction surgery.
6. Documentation requirements
To support a claim for CPT 19380, the following information should be documented:
- Patient’s medical history, including previous breast reconstruction surgery
- Physical examination findings, including the specific complications or cosmetic issues being addressed
- Preoperative photographs of the reconstructed breast
- Operative report detailing the procedure performed, including the techniques used and the extent of tissue removal or revision
- Postoperative photographs of the revised breast
- Follow-up care instructions and any additional treatments required
7. Billing guidelines
When billing for CPT code 19380, it is important to follow the specific guidelines and rules set forth by the payer. Some tips for billing this code include:
- Ensure that the documentation supports the medical necessity of the procedure
- Do not report CPT 19380 in conjunction with codes 12031, 12032, 12034, 12035, 12036, 12037, 13100, 13101, 13102, 15877, 19316, 19318, or 19370 for the same breast
- Verify the payer’s specific requirements for prior authorization or pre-certification
- Include any relevant modifiers, such as laterality, when applicable
8. Historical information
CPT 19380 was added to the Current Procedural Terminology system on January 1, 1990. The code was last changed on January 1, 2021, with an updated descriptor for the revision of a reconstructed breast.
9. Similar codes to CPT 19380
Five similar codes to CPT 19380 and how they differentiate are:
- CPT 19371: Periprosthetic capsulectomy, breast, which involves the removal of scar tissue around a breast implant without significant revision
- CPT 19366: Breast reconstruction with other technique, which may include less extensive revisions or adjustments to the reconstructed breast
- CPT 19340: Immediate insertion of breast prosthesis following mastopexy, mastectomy, or in reconstruction, which focuses on the initial placement of a breast implant
- CPT 19342: Delayed insertion of breast prosthesis following mastopexy, mastectomy, or in reconstruction, which involves the placement of a breast implant at a later time after the initial surgery
- CPT 19350: Nipple/areola reconstruction, which specifically addresses the reconstruction of the nipple and areola complex
Here are 10 detailed examples of CPT code 19380 procedures:
- Revision of a reconstructed breast following autologous tissue transfer due to flap necrosis
- Significant removal of tissue and repositioning of a breast implant to correct asymmetry
- Re-advancement and re-inset of flaps in autologous reconstruction to improve the breast contour
- Significant capsular revision combined with soft tissue excision in implant-based reconstruction to address capsular contracture
- Removal and replacement of a ruptured breast implant with significant revision of the implant pocket
- Revision of a reconstructed breast to address patient dissatisfaction with the overall appearance
- Correction of implant malposition with significant capsular revision and soft tissue excision
- Reconstruction of a breast mound following failed implant-based reconstruction using autologous tissue transfer and significant revision of the breast contour
- Removal of excess skin and fat from a reconstructed breast to improve symmetry with the contralateral breast
- Revision of a reconstructed breast to address complications related to radiation therapy, such as tissue fibrosis and contracture