When a patient has a mastectomy, the next step in their journey is often reconstruction of the breast. There are many different methods to reconstructing the breast. One method involves the placement of a tissue expander. A tissue expander is a small inflatable prosthesis that is implanted into the cavity left after the mastectomy surgery. The expander is typically placed at the same time as the mastectomy surgery but in some cases may be placed later on. After placing the expander, saline is then injected into the tissue expander slowly over time which causes the expander to enlarge and in turn causes the skin to stretch. Once the skin has stretched enough to allow placement of a breast implant, the tissue expander is removed and replaced with a permanent breast implant.
This article is dedicated to coding that second step of the procedure where the tissue expander is removed and a permanent breast implant is placed. There are two CPT codes to consider for this operation. CPT 11970 is for a routine removal of a tissue expander with insertion of a permanent breast implant, also known as a breast prosthesis. This code includes removal of the expander, measuring/sizing the mastectomy cavity to pick the correct implant for the patient, minor adjustments to the breast capsule to allow the implant to sit right, and inserting the implant itself.
Our other option for this surgery is CPT 19342. This code can be used for a more complicated tissue expander removal and breast implant insertion. The AMA has recommended using CPT 19342 when the procedure requires “significant capsular adjustments” to allow the breast implant to sit correctly. The AMA goes on to provide a couple of examples of adjustments that would support significant capsular adjustments including a radial capsulotomy, a partial or total capsulectomy, or raising/lowering the inframammary crease. When these procedures are performed to allow placement of a breast implant, they are not reported with separate CPT codes, but are considered included in CPT 19342.
