How To Use CPT Code 19318

CPT 19318 refers to breast reduction surgery, 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 19318?

CPT 19318 is a medical billing code used to describe breast reduction surgery. This procedure involves the removal of excess breast tissue, which may result from top scarring, calcification, or architectural distortion. The code is used by medical coders and billers to accurately document and bill for this specific surgical procedure.

2. 19318 CPT code description

The official description of CPT code 19318 is: “Breast reduction.”

3. Procedure

The 19318 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision around the areolar region.
3. Excess skin is removed in an innervated T scar pattern.
4. Parenchymal tissues are removed.
5. The nipple is reoriented into the proper position.
6. If necessary, drains are inserted.
7. The site is closed.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 19318 services include those experiencing physical discomfort, pain, or functional impairment due to the size and weight of their breasts. This may include symptoms such as back, neck, or shoulder pain, skin irritation, or difficulty with physical activities. Additionally, patients with a history of unsuccessful conservative treatments, such as physical therapy or pain management, may also qualify for this procedure.

5. When to use CPT code 19318

It is appropriate to bill the 19318 CPT code when a patient undergoes breast reduction surgery to alleviate symptoms related to the size and weight of their breasts. This code should be used by medical coders and billers to accurately document and bill for this specific surgical procedure.

6. Documentation requirements

To support a claim for CPT 19318, the following information should be documented:

• Patient’s medical history, including symptoms and conservative treatments tried.
• Physical examination findings, such as breast size, skin irritation, or shoulder grooving.
• Preoperative photographs to demonstrate the size and appearance of the breasts.
• Operative report detailing the surgical procedure, including the amount of tissue removed and any complications encountered.
• Postoperative care instructions and follow-up appointments.

7. Billing guidelines

When billing for CPT code 19318, it is essential to follow the specific guidelines and rules set forth by the payer. Some tips for billing this code include:

• Ensure that all required documentation is complete and accurate.
• Verify the patient’s insurance coverage for breast reduction surgery.
• Obtain any necessary preauthorization or referrals from the patient’s insurance provider.
• Bill any related codes, such as anesthesia or facility fees, as appropriate.

8. Historical information

CPT 19318 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 “Reduction mammaplasty.”

9. Similar codes to CPT 19318

Five similar codes to CPT 19318 include:

• CPT 19316: This code refers to mastopexy, which is a breast lift procedure that does not involve the removal of breast tissue.
• CPT 19324: This code is used for breast augmentation with the insertion of an implant.
• CPT 19325: This code describes breast augmentation with the use of autologous tissue.
• CPT 19328: This code refers to the removal of a breast implant without replacement.
• CPT 19330: This code is used for the removal of breast tissue for gynecomastia treatment in males.

10. Examples

Here are 10 detailed examples of CPT code 19318 procedures:

1. A 35-year-old female with a history of chronic back pain and shoulder grooving undergoes breast reduction surgery to alleviate her symptoms.
2. A 28-year-old female with a history of skin irritation and infections beneath her breasts undergoes breast reduction surgery to improve her quality of life.
3. A 40-year-old female with a history of unsuccessful conservative treatments for neck pain related to her breast size undergoes breast reduction surgery.
4. A 45-year-old female with a history of difficulty participating in physical activities due to the size and weight of her breasts undergoes breast reduction surgery.
5. A 50-year-old female with a history of breast asymmetry and related discomfort undergoes breast reduction surgery to achieve a more balanced appearance.
6. A 38-year-old female with a history of chronic headaches and shoulder pain related to her breast size undergoes breast reduction surgery to alleviate her symptoms.
7. A 42-year-old female with a history of poor posture and spinal curvature related to her breast size undergoes breast reduction surgery to improve her spinal alignment.
8. A 48-year-old female with a history of sleep disturbances and discomfort related to her breast size undergoes breast reduction surgery to improve her sleep quality.
9. A 32-year-old female with a history of difficulty finding properly fitting clothing and bras due to her breast size undergoes breast reduction surgery to improve her daily comfort.
10. A 36-year-old female with a history of emotional distress and self-consciousness related to her breast size undergoes breast reduction surgery to improve her self-esteem and overall well-being.