Summary & Overview
CPT 19361: Breast Reconstruction with Latissimus Dorsi Flap, No Implant
CPT code 19361 represents breast reconstruction using a latissimus dorsi flap without the use of a prosthetic implant. This surgical procedure is a critical option for patients undergoing mastectomy, providing a natural tissue reconstruction alternative. Nationally, this code is significant in the context of cancer care and reconstructive surgery, as it addresses both clinical and quality-of-life outcomes for patients affected by breast cancer and related conditions.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication offers insights into payer coverage, clinical benchmarks, and policy updates relevant to this code. Readers will gain an understanding of the procedure's clinical context, typical site of service, and its role within the broader landscape of breast reconstruction options. The analysis also highlights associated diagnoses, related CPT codes, and common billing modifiers, providing a comprehensive overview for stakeholders in healthcare policy, billing, and clinical practice.
This summary serves as a resource for understanding the national importance of CPT code 19361, including payer coverage and procedural benchmarks, without referencing state-specific data. It is intended for professionals seeking clarity on coding, reimbursement, and clinical application in breast reconstruction surgery.
CPT Code Overview
CPT code 19361 describes breast reconstruction with latissimus dorsi flap, without prosthetic implant. This procedure is a form of plastic and reconstructive surgery typically performed in an inpatient hospital setting. It involves using the latissimus dorsi muscle and overlying skin from the back to reconstruct the breast, often following mastectomy due to cancer or other conditions. The absence of a prosthetic implant distinguishes this approach from other reconstruction methods, offering patients a natural tissue option for breast restoration.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an individual who has undergone a mastectomy due to breast cancer or another malignant neoplasm affecting the breast. The patient is admitted to an inpatient hospital setting for breast reconstruction using a latissimus dorsi muscle flap, without the placement of a prosthetic implant. The procedure is performed by a plastic and reconstructive surgeon, sometimes in collaboration with a surgical oncologist, to restore the breast's contour and appearance following cancer treatment. The clinical workflow includes preoperative assessment, surgical planning, intraoperative harvesting and transfer of the latissimus dorsi flap, and postoperative care to monitor for complications and ensure optimal healing.
Coding Specifications
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Modifier
51(Multiple Procedures): Used when more than one procedure is performed during the same operative session. This modifier indicates that the procedure is part of a group of multiple procedures. -
Modifier
62(Two Surgeons): Applied when two surgeons are required to perform distinct parts of the procedure, each acting as a primary surgeon.
| Modifier Code | Description |
|---|---|
51 |