How To Use CPT Code 19370

CPT code 19370 describes the surgical procedure of revising the peri-implant capsule in the breast, which involves releasing the scar tissue that forms around a previous breast implant. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 19370?

CPT 19370 is a code used to describe the surgical revision of the peri-implant capsule in the breast. This procedure involves releasing the scar tissue that forms around a previous breast implant. It is performed to address issues such as pain caused by scar tissue contraction or malpositioning of the breast implant.

2. Official Description

The official description of CPT code 19370 is: ‘Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy.’

Notes: (Do not report 19370 in conjunction with 19328 for removal and replacement of the same implant to access the capsule) (For removal and replacement with a new implant, use 19342)

3. Procedure

During the procedure, the healthcare provider surgically releases the capsule, or scar tissue, that forms within the breast tissue around a previous implant. This is done to alleviate pain caused by scar tissue contraction or to address malpositioning of the breast implant.

The provider begins by making an incision in the mastectomy or implant scar on the skin of the breast. This allows them to locate the implant. They then incise the breast tissue and release the scar tissue from around the implant. In some cases, they may remove part of the capsule of scar tissue and/or reposition the implant. Once the desired corrections have been made, the provider closes the operative site in layers to achieve hemostasis.

4. Qualifying circumstances

CPT 19370 is performed on patients who have previously undergone breast implant surgery and have developed scar tissue around the implant. The procedure is indicated when the scar tissue causes pain or when the breast implant is malpositioned. It is important to note that CPT 19370 should not be reported in conjunction with CPT 19328 for the removal and replacement of the same implant to access the capsule. If a new implant is being inserted, CPT 19342 should be used instead.

5. When to use CPT code 19370

CPT code 19370 should be used when a healthcare provider performs a surgical revision of the peri-implant capsule in the breast. This includes procedures such as capsulotomy, capsulorrhaphy, and/or partial capsulectomy. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT 19370, the healthcare provider must document the following information:

• Patient’s diagnosis indicating the need for peri-implant capsule revision
• Details of the procedure performed, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures performed, such as repositioning of the implant
• Documentation of achieving hemostasis
• Operative site closure details

7. Billing guidelines

When billing for CPT 19370, it is important to ensure that the procedure meets the specific criteria outlined in the official description. Additionally, CPT 19370 should not be reported in conjunction with CPT 19328 for the removal and replacement of the same implant to access the capsule. If a new implant is being inserted, CPT 19342 should be used instead.

8. Historical information

CPT 19370 was added to the Current Procedural Terminology system on January 1, 1990. The code was later updated on January 1, 2021, with the addition of the descriptor ‘Open periprosthetic capsulotomy, breast.’

9. Similar codes to CPT 19370

There are several similar codes to CPT 19370 that are used to describe other repair and reconstruction procedures on the breast. 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: Removal and replacement of breast prosthesis, including capsulectomy, when performed

9. Examples

1. A patient who previously underwent breast implant surgery experiences pain due to scar tissue contraction. The healthcare provider performs a revision of the peri-implant capsule, including capsulotomy and partial capsulectomy, to alleviate the pain.
2. A patient’s breast implant is malpositioned, causing asymmetry. The healthcare provider performs a revision of the peri-implant capsule, including capsulorrhaphy, to correct the positioning of the implant.
3. A patient develops capsular contracture, resulting in a distorted appearance of the breast. The healthcare provider performs a revision of the peri-implant capsule, including capsulotomy and capsulorrhaphy, to address the contracture and improve the aesthetic outcome.
4. A patient experiences pain and discomfort due to scar tissue formation around a breast implant. The healthcare provider performs a revision of the peri-implant capsule, including capsulotomy and partial capsulectomy, to relieve the symptoms.
5. A patient’s breast implant becomes displaced, causing asymmetry and discomfort. The healthcare provider performs a revision of the peri-implant capsule, including capsulorrhaphy and partial capsulectomy, to reposition the implant and improve the patient’s satisfaction.
6. A patient undergoes breast implant removal and replacement due to complications. The healthcare provider performs a revision of the peri-implant capsule, including capsulotomy and capsulorrhaphy, during the procedure to address scar tissue and ensure optimal results.