Summary & Overview
CPT 19367: Pedicled TRAM Flap Breast Reconstruction
CPT code 19367 covers autologous pedicled TRAM (transverse rectus abdominis myocutaneous) flap breast reconstruction, a commonly used reconstructive option after mastectomy or for repair of breast defects. This procedure restores breast contour by transferring a vascularized flap of lower abdominal skin, fat, and muscle while maintaining a pedicle for blood supply. Nationally, reconstruction after breast removal is an important component of comprehensive cancer and reconstructive care, with implications for surgical access, facility resource use, and post-operative recovery pathways.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise presentation of clinical context, typical sites of service, and the service type for 19367. The publication outlines benchmark elements and policy-relevant considerations such as payer coverage patterns, authorization practices, and facility implications. It also summarizes where to expect clinical and administrative variation and highlights areas where additional documentation or review commonly arises. Data not available in the input will be indicated where applicable.
Billing Code Overview
CPT code 19367 describes a surgical breast reconstruction procedure using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap. The provider harvests a flap of skin, fat, and transverse rectus abdominis muscle from the lower abdomen while leaving a vascularized tissue pedicle attached to the original site, then transposes and sutures the flap to the breast site to recreate the breast contour after mastectomy or to repair a breast defect.
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Service type: Autologous tissue breast reconstruction using a pedicled TRAM flap
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Typical site of service: Inpatient surgical setting or ambulatory surgical center for reconstructive breast surgery
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman following mastectomy for breast cancer who presents for staged autologous reconstruction using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap (19367). The patient is evaluated preoperatively in a multidisciplinary clinic including the breast surgeon, plastic surgeon, medical oncology and radiation oncology as applicable. Preoperative workup includes medical optimization, review of prior oncologic treatments (chemotherapy, radiation), vascular and abdominal wall assessment, imaging as needed, and consent for potential bilateral reconstruction or symmetry procedures.
Intraoperative workflow involves general anesthesia, prophylactic antibiotics, marking of the lower abdominal donor site, elevation of the pedicled TRAM flap with preservation of a vascularized pedicle, transfer of the flap to the chest and inset to recreate breast contour, possible placement of drains, and layered closure of donor and recipient sites. Postoperative care includes monitoring flap perfusion, pain control, deep venous thrombosis prophylaxis, wound and drain management, and coordination of follow-up for adjuvant therapy or revision procedures when indicated.
A realistic scenario: a 52-year-old woman with left mastectomy six months prior, no active metastatic disease, cleared by oncology, elects delayed unilateral breast reconstruction with a pedicled TRAM flap (19367) to restore breast contour. Surgery is performed in an ambulatory surgical center or hospital operating room with an anticipated inpatient overnight stay for flap monitoring.
Coding Specifications
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