Category: Article

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.

When someone says chest tube insertion, most coders immediately think of CPT 32551 as the code to represent this procedure. While CPT 32551 is certainly one valid code for a chest tube insertion into the pleura, it is not the only code that can describe this procedure. To ensure we select the correct CPT code, the main key we need to look for in the procedure report is the  approach to the procedure. A chest tube may be inserted through an open approach or a percutaneous approach. Continue reading “Chest Tubes” →

A fusion of the vertebrae, which is also known as an arthrodesis procedure, is a procedure performed to cause a part of two or more vertebrae to “fuse” together over time. The procedure involves placing bone graft between the parts of the vertebrae the physician wants to fuse together. The goal of the procedure is to prevent movement of vertebrae which are causing the patient pain and also helps to stabilize the spine when it has been compromised by disease. Some common diseases that impact the spine include but are not limited to degenerative disk disease, spondylosis, and spondylolisthesis.

Fusions are first classified as either anterior fusions where the surgeon makes an incision from the front of the body and works his way down to the spine or as posterior where the surgeon makes an incision from the back of the body and works his way down to the spine that way. For posterior fusions, we then have some more options – the fusion can be posterior/posterolateral only, interbody, or combined. When an operative report directly tells us what type of fusion is performed, it can be straightforward to line up the term posterior, interbody, or combined fusion to the code descriptions in the CPT manual. But what happens when the surgeon doesn’t use one of these terms? Are we unable to code the procedure without getting additional information from the physician? Fortunately for us coders, there are some keys we can look for to help us determine the type of fusion performed. Continue reading “Interbody, Posterior, and Combined Fusions” →

If you look in the CPT manual, you have many options for coding laryngoscopies based on the “type” of laryngoscopy performed.  Can you tell the difference between a flexible, indirect, and direct laryngoscopy?

A flexible laryngoscopy uses a thin flexible tube to examine the larynx. Continue reading “Laryngoscopy” →

**Updated 1/26/20 to reflect 2020 CPT Changes**

One method of treating complex aortic aneurysms is a procedure called an elephant trunk procedure.  This procedure has two parts that can be done during the same surgery or may be done during two different surgeries in something known as a staged procedure.

In the first part of the procedure, the aortic arch is replaced with a graft. In the second part of the procedure, the surgeon places a piece of graft into the descending thoracic aorta. Sometimes if the aneurysm is lower down in the thoracic aorta this piece of graft may extend into the thoracoabdominal aorta. This piece of graft attaches to the end of the graft used to replace the aortic arch in the first part of the procedure and hangs down into the descending thoracic aorta or thoracoabdominal aorta and looks like an elephant’s trunk which is where this procedure gets its name. Continue reading “Elephant Trunk Graft Procedure” →

**Updated 1/26/20 to reflect 2020 CPT Changes**

**Updated 8/2/20 to reflect change in edits from CMS**

When it comes to coding aortic graft procedures, a couple of factors have to be considered to arrive at the correct CPT code.

1) What section of the aorta is the graft being placed in? The aorta is divided into the following sections:

– The abdominal aorta which begins at the level of the diaphragm (the muscle that separates your chest cavity from your abdomen) and continues to what is known as the iliac bifurcation where the abdominal aorta branches into the right and left common iliac arteries which supply blood flow to your legs.

– The descending thoracic aorta which begins at the lower end of the aortic arch (explained below) and proceeds down to the level of the diaphragm.

– The aortic arch which is located between the ascending aorta and the descending thoracic aorta and is the portion of the aorta that the “head vessels” (the subclavian, the carotid, and the brachiocephalic trunk arteries which supply blood flow to the head, neck, and arms) branch off of.

– The ascending aorta which begins at the upper end of the aortic arch and continues through the aortic root and down to the aortic valve.  The aortic root is where the coronary arteries which supply blood flow to your heart connect to the aorta.  The aorta ends at this point (the heart is located on the other side of the aortic valve). Continue reading “Ascending Aortic Graft Placement” →