2021 ASC Coding Tips: Breast Reconstruction Coding Changes
By Mandeara Frye, RHIA, CPC, CPMA, CASCC, Director of Coding
The breast reconstruction CPTs went through some pretty big changes this year. It’s important to make sure your surgeons, coders, billers, and authorization/scheduling staff understand these changes and how they impact your coding.
19380 Revision of reconstructed breast (e.g., 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 description for 19380 was revised to give users more information regarding what is included in this code. This code is still to only be used for patients who have undergone previous mastectomy and completed reconstruction, who now require revision. This code still encompasses multiple techniques used in revision; however, it no longer includes fat grafting (15771-15772) which is now separately reportable for FY 2021. The insertion or exchange of a breast implant is also separately reportable.
19340 Insertion of breast implant on same day of mastectomy (i.e., immediate)
19342 Insertion or replacement of breast implant on separate day from mastectomy
The breast insertion CPTs were revised for 2021 as well, to now specify either on the same day of a mastectomy or at a later date. Previously, 19340 could be reported on the same date as other breast procedures, however now it must be done on the same date of service as the mastectomy.
19325 Breast augmentation with implant
While this CPT didn’t change this year, its use will become more widespread to replace scenarios where 19340 may have been coded, such as for an implant placement after mastopexy (19316) on a breast that has not previously undergone post-mastectomy reconstruction. While 19325 has previously been associated with primarily cosmetic procedures, it is appropriate to use for medically necessary implant placements as well. As always, make sure you check with your payers regarding any specific diagnosis or authorization requirements.