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Tip: Understand breast capsule procedures

Ambulatory Surgery Reimbursement Update, May 27, 2008

It is important to understand the difference in procedures physicians perform to treat complications from previous placement of breast implants. In particular, pay close attention to the differences between capsulotomy and capsulectomy procedures, which include the following:

• Capsulotomy procedures are less extensive than capsulectomy procedures. Physicians perform these procedures to enlarge the pocket of a contracted breast capsule from previous implants to relieve pain and tightness. Report capsulotomy procedures with CPT code 19370.
• Capsulectomy procedures are more extensive and also involve a contracted capsule from breast implants. In capsulectomy procedures the physician excises the capsule from the breast tissue and removes the implant. Report capsulectomy procedures with CPT code 19371.

If a physician performs a capsulectomy procedure on a patient with breast implants, the procedure includes the removal of the old (intact) implants, and is not separately-billable. If an implant has ruptured, the removal of implant material is separately-billable. However, check the national correct coding initiative updates to be sure, since they are quarterly.

This tip is brought to you by Ellis Medical Consulting, Inc.

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