How To Use CPT Code 19325

CPT code 19325 describes a procedure known as breast augmentation with implant. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 19325?

CPT code 19325 is used to describe a procedure called breast augmentation with implant. This procedure involves increasing the size and volume of the breast by placing a breast implant. It is typically performed by a qualified healthcare provider.

2. Official Description

The official description of CPT code 19325 is: ‘Breast augmentation with implant.’

3. Procedure

During the breast augmentation procedure with implant, the healthcare provider begins by making an incision in the breast. This incision can be made in different locations, such as peri-areolar, inframammary, or trans-axillary. The choice of incision location depends on various factors, including the patient’s anatomy and the desired outcome.

Once the incision is made, the provider creates pockets in the peripectoral or subglandular area and posterior capsule of the breast. These pockets serve as the space where the breast implant will be placed. The breast implant can be filled with either saline or silicone gel, depending on the patient’s preference and the provider’s recommendation.

After inserting the breast implant, the healthcare provider ensures hemostasis, which means stopping any bleeding. Finally, the incisions are closed with sutures.

4. Qualifying circumstances

CPT code 19325 is used for breast augmentation procedures with implants. It is typically performed for cosmetic purposes to enhance the size and volume of the breasts. The procedure may be appropriate for patients who desire a change in breast size or shape, or for those who have undergone mastectomy and wish to reconstruct their breasts.

5. When to use CPT code 19325

CPT code 19325 should be used when a healthcare provider performs breast augmentation with implant. This code is specific to procedures involving the placement of breast implants to increase breast size or to replace breast tissue after mastectomy. It is important to follow payer reporting guidelines for reporting bilateral services if the procedure is performed on both breasts.

6. Documentation requirements

To support a claim for CPT code 19325, the healthcare provider must document the following information:

• Patient’s diagnosis or reason for the procedure
• Details of the procedure, including the type of incision made and the location of the pockets created
• Type of breast implant used (saline or silicone gel)
• Date of the procedure
• Any additional relevant information, such as the patient’s preferences or specific considerations
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 19325, ensure that the procedure performed is breast augmentation with implant. It is important to follow payer guidelines and coding rules for reporting bilateral services if the procedure is performed on both breasts. It is also essential to use the appropriate modifiers, if required, to indicate any additional procedures or circumstances related to the breast augmentation.

8. Historical information

CPT code 19325 was added to the Current Procedural Terminology system on January 1, 1990. The code was later changed on January 1, 2021, with the updated description of ‘Mammaplasty, augmentation with prosthetic implant.’

9. Similar codes to CPT 19325

There are several similar codes to CPT code 19325 that are used to describe other breast-related procedures. Some of these codes include:

• CPT 19316: Mastopexy
• CPT 19318: Reduction mammaplasty
• CPT 19324: Breast reconstruction with latissimus dorsi flap
• CPT 19340: Immediate insertion of breast prosthesis following mastopexy, mastectomy, or in reconstruction
• CPT 19342: Delayed insertion of breast prosthesis following mastopexy, mastectomy, or in reconstruction

9. Examples

1. A patient undergoes breast augmentation with implant to increase the size and volume of her breasts for cosmetic purposes.
2. A breast cancer survivor chooses to have breast reconstruction with implant after undergoing mastectomy.
3. A patient desires to enhance the shape and size of her breasts and undergoes breast augmentation with implant.
4. A transgender individual undergoes breast augmentation with implant as part of their gender-affirming journey.
5. A patient with breast asymmetry undergoes breast augmentation with implant to achieve a more balanced appearance.
6. A patient who has lost breast volume due to weight loss undergoes breast augmentation with implant to restore fullness.
7. A patient with tuberous breasts undergoes breast augmentation with implant to correct the shape and size of her breasts.
8. A patient who desires a more proportionate figure undergoes breast augmentation with implant to achieve the desired aesthetic outcome.
9. A patient who has undergone multiple pregnancies and breastfeeding chooses to have breast augmentation with implant to restore the shape and volume of her breasts.
10. A patient with Poland syndrome, a congenital condition characterized by underdeveloped or absent chest muscles, undergoes breast augmentation with implant to improve the appearance of her chest.