cpt 19325, cpt code 19325, 19325 cpt code

CPT Code 19325 | Description & Clinical Information

The CPT code 19325 refers to a medical procedure involving breast augmentation with an implant. This surgical procedure aims to enhance the patient’s breast size, shape, and volume by inserting an artificial implant.

Description

The CPT book defines CPT code 19325 as “Breast augmentation with implant.”

Billing Guidelines

It is essential to note that if fat grafting is performed with the breast augmentation procedure, the appropriate codes to report are 15771 and 15772. These procedures should be billed accordingly to ensure proper documentation and reimbursement.

Clinical Responsibility

Before breast augmentation surgery, healthcare providers carry out several essential tasks to ensure the patient’s safety and the procedure’s success. A detailed clinical responsibility section will cover these tasks, from pre-operative preparations to the surgical process and post-operative care.

1. Pre-operative preparations: Before the surgery, the medical team ensures that the patient is adequately prepped, which includes obtaining informed consent, administering anesthesia, and sterilizing the operative site. It is crucial to verify the general or local anesthesia type, as it varies depending on the patient’s condition and preferences.

2. Incision creation: After administering anesthesia and preparing the surgical site, the provider, typically a plastic surgeon, makes a carefully planned incision in the patient’s breast. The chosen incision type typically falls under three main categories: peri-areolar, inframammary, or trans-axillary incisions. The selection of the incision type depends on the patient’s anatomy, the implant’s size, and the surgeon’s experience and preferences.

3. Pocket creation and implant placement: The surgeon creates a pocket to accommodate the breast implant following the incision. This pocket can be created in the peripectoral or sub-glandular area or the posterior capsule of the breast, particularly in the case of an inframammary incision. After creating the pocket, the surgeon inserts the chosen implant, which can be either saline or silicone-filled, depending on the patient’s preferences and needs.

4. Hemostasis and wound closure: Ensuring hemostasis is vital in the breast augmentation procedure. The provider diligently identifies and controls any bleeding points throughout the surgery. Once hemostasis is achieved, the surgeon closes the incisions using sutures or other appropriate wound closure techniques.

Unilateral and Bilateral Procedures

It is crucial to recognize that the CPT® code 19325 represents a unilateral service, meaning it pertains to a breast augmentation procedure performed on a single breast.

One should consult and follow the payer-specific reporting guidelines to report a bilateral procedure or breast augmentation performed on both breasts during the same surgical session.

This consideration is necessary to ensure accurate coding and reimbursement for bilateral breast augmentation procedures

Conclusion

Understanding the CPT® code 19325 and related codes ensures proper documentation, reporting, and reimbursement for breast augmentation and associated procedures.

Providers and medical coders should be mindful of the clinical responsibilities, procedural details, and reporting guidelines to facilitate accurate claims submissions and minimize the risk of denied or delayed reimbursements.

A detailed understanding of breast augmentation with implant procedures, the roles of the healthcare providers, and correct CPT® codes and guidelines fosters a seamless billing process. In addition, it contributes to the overall efficiency of the medical practice.

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