This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
There were no new integumentary CPT codes added however there were 2 deletions and 17 significant CPT code revisions, mostly to breast procedure codes.
Mastectomy and Breast Procedures in General
In the past, coders have had difficulty in trying to figure out the best breast procedure code for various types of revisions and for other breast procedures. They include capsulectomies, tissue expander and breast prosthesis replacements and work on the past reconstruction itself. The AMA has extensively revised the subsection notes and code descriptions to better assist coders. It is HIGHLY RECOMMENDED that all coders read the extensive revision of notes in the breast procedure subsection of CPT 19316-19396. These notes will explain why and how reconstructions are done. They also explain that each technique can stand alone, and both breasts may be reconstructed at the same time but utilizing different techniques. They also explain that 11970 describes removal and replacement of tissue expander at same time and includes minor capsule revisions. More extensive capsule revisions need to be well documented and code 19370 can then be added. The capsule is the fibrous area that surrounds the breast implant.
Across the subsection, the term “prosthesis” was replaced with “implant” to better describe that implants are used in breast surgeries. Also terms such as ‘reduction mammaplasty” were changed to just reflect “breast reduction.”
Breast Implants vs Tissue Expanders
Code “19324 – Mammaplasty, augmentation, WITHOUT prosthetic implant” has been deleted. In it’s place, coders are instructed to assign 15771 or 15772 for augmentation using fat grafting.
For 19328, Removal of intact breast implant, notes were added to tell the coder to NOT report this code for removal of a tissue expander, which is different than the actual permanent breast implant. A tissue expander is used at time of initial reconstruction to expand the remaining breast tissue enough to accept the permanent breast implant that is inserted later.
Code 19330 to was revised to “Removal of ruptured breast implant, including implant contents (e.g., saline, silicone gel. Previously this code had just stated removal of mammary implant material. The description update helps coders to understand that 19330 is for removal of a ruptured implant AND would include any material that is spilled out in the breast area. There is not a separate code reported for that. So the difference between 19328 and 19330 is whether or not the breast implant is ruptured or not. And remember, these codes are NOT for breast tissue expanders.
If a tissue expander is removed and a permanent breast implant placed, the coder is to use 11970. If the tissue expander is removed and nothing is placed back in after its removal, assign 11971.
Insertion of breast implants (not tissue expanders) codes were updated as follows:
19340 Insertion of breast implant on same day of mastectomy (i.e., immediate) (had stated immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction)
19342 Insertion or replacement of breast implant on separate day from mastectomy (had stated delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction)
These codes are now very clear as to when the insertion or replacement of the breast implant occurs. This lessens the confusion for coders. Also there are notes underneath these codes in the CPT tabular to read.
Two code descriptions were updated as follows:
19357 Tissue expander placement in breast reconstruction, including subsequent expansion(s)(previously stated breast reconstruction, immediate or delayed, including subsequent expansion) The subsequent expansions of the tissue expander is included in the code 19357.
19361 Breast reconstruction; with latissimus dorsi flap (had said the same plus “without prosthetic implant”) Read extensive notes of what not to report with this code. I there is insertion of an implant in addition to latissimus dorsi flap on same day, code 19340 in addition to 19361. If a separate day, use 19342.
Codes 19364-19369 are breast reconstruction codes using various types of flap grafts such as fTRAM, DIEP, SIEA, bi=pedicled TRAM, TRAM with and without separate microvascular anastomosis or “supercharging.” Supercharging is typically performed to increase blood flow in TRAM flaps with marginal circulation to ensure flap survival. These procedures are really the same as in 2020, the only difference in description is that they all had stated “including closure of donor site.” This is of course just part of the code. The notes before these codes explain a bit better what is done in each type of flap.
Breast Procedure Revisions
Coders previously had trouble discerning reconstruction or revision of breast reconstructions. The three main codes were revised in their descriptions as follows:
19370 Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy (had stated open periprosthetic capsulotomy, breast) This is usually done for displacement of the implant.
19371 Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents (had stated open periprosthetic capsulectomy, breast) The key here is COMPLETE capsulectomywith implant removal. This was added to make it clear. 19370 is used for PARTIAL capsulectomy. Physicians will need t be clear in their documentation!
(Do not report 19371 with 19328, 19330, or 19370 in the same breast. For removal and replacement with new implant, use 19342)
19380 Revision of reconstructed breast (eg, 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 (had stated revision of reconstructed breast). This code description is probably the code description most extensively revised. A full listing of codes not to report this with is in the CPT tabular so coders must reference those notes.
Documentation is very important in all of the breast procedure codes. Facilities may want to meet with their surgeons to review the changes above so that documentation needed for coders is included in operative reports.
We advise coders to utilize our Breast Reconstruction in CPT Action Plan and also to view photos online of the various techniques used in breast reconstruction. Sometimes seeing these visually helps to better understand what is being done.
The only other code addition for integument was:
0598T Noncontact real-time fluorescence wound imaging, for bacterial presence, location, and load, per session; first anatomic site (eg, lower extremity)
+0599T each additional anatomic site (eg, upper extremity)
The use of real time fluorescence wound imaging assists the provider in diagnosing the dept of a wound and the bacterial load. A hand held device “sees through” the wound using fluorescence technology.
In Part 2, we will discuss musculoskeletal and respiratory CPT code changes.
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.