Summary & Overview
CPT 19340: Removal of Intact Breast Implant with Internal Capsulotomy
CPT code 19340 is a critical billing code for the removal of an intact breast implant, including internal capsulotomy when performed, as part of reconstructive breast surgery. This procedure is frequently required for patients with medical indications such as malignancy or complications related to breast implants. The code is typically used in hospital outpatient settings and is billed in addition to the primary surgical procedure.
Major national payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Understanding the nuances of 19340 is important for providers, payers, and policy analysts, as it impacts reimbursement, coding accuracy, and compliance with clinical guidelines. The publication provides insights into payer coverage, common billing practices, and the clinical context for when this procedure is performed.
Readers will gain a comprehensive overview of benchmarks, policy updates, and the clinical landscape surrounding breast implant removal. The article also highlights related codes and modifiers, offering clarity on how 19340 fits within broader reconstructive breast surgery billing and coding practices. This information is valuable for stakeholders seeking to stay informed about evolving standards in surgical oncology and plastic surgery.
CPT Code Overview
CPT code 19340 represents the removal of an intact breast implant, including internal capsulotomy when performed. This procedure is typically part of reconstructive breast surgery and is often conducted in a hospital outpatient setting, most commonly at place of service 22. The code is listed separately in addition to the primary procedure, reflecting its role as an adjunct to more comprehensive surgical interventions. This service is essential for patients requiring implant removal due to medical necessity, such as complications or oncologic indications.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a patient who previously underwent breast reconstruction or augmentation with an implant, often following treatment for breast cancer or other breast malignancies. The patient now requires removal of an intact breast implant, which may be indicated due to complications such as capsular contracture, implant rupture, infection, or recurrence of malignancy. The procedure includes an internal capsulotomy when performed. The clinical workflow generally involves preoperative assessment, imaging, surgical planning, and coordination with oncology or plastic surgery teams. The service is most commonly performed in a hospital outpatient setting, such as Place of Service 22.
Coding Specifications
| Modifier Code | Description | When to Use |
|---|---|---|
50 | Bilateral Procedure | When the procedure is performed on both breasts during the same operative session. |
RT | Right Side | When the procedure is performed on the right breast. |
LT |