Summary & Overview
CPT 19355: Correction of Inverted Nipple
CPT code 19355 represents a minor reconstructive breast surgery used to correct inverted nipples by releasing ducts and fibrous attachments. This procedure is relevant across outpatient surgical settings and ambulatory surgery centers and has implications for plastic and reconstructive surgeons, breast specialists, and surgical billing teams. Nationally, accurate coding of this procedure affects procedure reporting, quality measurement, and claims processing for breast reconstruction and aesthetic/restorative breast care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, common billing context, and an overview of coding considerations relevant to provider offices and billing departments. The publication outlines typical sites of service and service type, clarifies the procedural intent, and identifies common modifiers and payer relationships where available. Where specific data elements are not provided in the input, the report notes that data is not available in the input.
This summary equips clinicians, coding professionals, and policy analysts with the essential context needed to understand CPT code 19355, its clinical role in nipple reconstruction, and the payer landscape for national-level discussion of coding and reimbursement practices.
Billing Code Overview
CPT code 19355 describes a surgical procedure for correction of inverted nipples by releasing the ducts and supporting fibers that hold the nipple inward. The procedure focuses on freeing the tethering structures to allow projection of the nipple.
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Service type: Minor reconstructive breast surgery
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Typical site of service: Outpatient surgical suite or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 28-year-old female presents to a plastic surgery clinic with symptomatic bilateral inverted nipples that interfere with breastfeeding and cause recurrent mastitis. After evaluation, conservative measures (e.g., suction devices, noninvasive traction) were attempted without durable improvement. The surgeon schedules a local procedure under local anesthesia with sedation or short general anesthesia to release the lactiferous ducts and fibrous bands tethering the nipple, correct inversion, and preserve as much ductal tissue as possible for future lactation.
Preoperative workflow includes informed consent documenting goals and risks, targeted breast exam, photographic documentation, and markup of operative sites. On the day of service, the procedure is typically performed in an outpatient ambulatory surgery center or hospital outpatient department; start and stop times, operative findings (degree of inversion, unilateral vs bilateral), and any intraoperative complications are documented. Postoperative instructions cover wound care, breastfeeding guidance, and follow-up visits for wound check and assessment of nipple projection and sensation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, uncomplicated service | Use for the primary procedure when no unusual circumstances altered performance. |
22 | Increased procedural services | Use when documentation supports substantially greater work or time than typical for 19355. |
52 | Reduced services | Use when the service is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances. |
50 | Bilateral procedure | Use when 19355 is performed on both nipples and payer requires a bilateral modifier instead of bilateral CPT modifier convention. |
RT | Right side | Use to identify the right nipple when reporting laterality instead of modifier 50. |
LT | Left side | Use to identify the left nipple when reporting laterality instead of modifier 50. |
63 | Procedure performed on infants less than 4 kg | Use when patient size/age meets the modifier's criteria if applicable. |
23 | Unusual anesthesia | Use when local anesthesia with monitored anesthesia care requires reporting of unusual anesthesia circumstances. |
59 | Distinct procedural service (Note: not in provided list) | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207P00000X | Plastic Surgery | Surgeons who commonly perform nipple inversion release and aesthetic/breast-conserving procedures. |
207L00000X | General Surgery | General surgeons with breast specialty experience may perform this procedure. |
207K00000X | Obstetrics & Gynecology | OB/GYN providers may perform nipple release in lactation-related cases. |
363A00000X | Family Medicine | Family physicians with minor procedure skills may manage simple cases or initial referral. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N64.89 | Other specified disorders of breast | Captures nipple inversion and other noninfectious structural breast issues when a more specific code is not applicable. |
N64.3 | Galactorrhea | Relevant when abnormal nipple discharge accompanies inversion and requires evaluation before corrective procedures. |
N61 | Inflammatory disorders of breast | Used when mastitis or recurrent infection is present in association with inverted nipples. |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | May apply when areolar or periareolar skin conditions contribute to inversion. |
Z41.2 | Encounter for routine checking of plastic and cosmetic surgery status | Used for preoperative or postoperative assessment in cosmetic correction contexts. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19316 | Mastopexy, augmentation with implant | Performed when correction of nipple inversion is combined with breast lift and augmentation planning in more extensive reconstructive cases. |
19000 | Puncture aspiration of cyst, or similar lesion | May be performed preoperatively for diagnostic relief if a subareolar abscess or cyst contributes to inversion or infection. |
12032 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 2.5 cm to 7.5 cm | Example code for intermediate closures; minor revisions of the nipple-areolar complex may require appropriate closure coding depending on repair complexity. |
11100 | Biopsy of single skin lesion | Used when a suspicious areolar lesion requires pathologic diagnosis prior to definitive correction. |
99213 | Office/outpatient visit, est. patient, 15 minutes | Typical preoperative or postoperative office visit level commonly reported during the care episode. |
99024 | Postoperative follow-up visit global period excluded | Used to report an unrelated postoperative visit occurring during the global period of 19355. |