2025 CPT code 19380
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Integumentary System Feed
Revision of reconstructed breast (e.g., significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)
Modifiers 22, 50, 51, 52, 53, 54, 55, 56, 58, 59, 73, 74, 76, 77, 78, 79, LT, RT, and others may be applicable depending on the specific circumstances.
Medical necessity must be established by documenting the functional or cosmetic impairment caused by the initial reconstruction and how the revision surgery addresses these issues.Pre-operative and post-operative photographs are often helpful.
The physician prepares the patient and administers anesthesia.They remove excess tissue, skin, and fat to reshape the breast.They may also revise the scar tissue surrounding a breast implant.Drains are placed if necessary, and the incision is closed.
In simple words: Breast revision is performed to improve unacceptable cosmetic appearance or other complication. The surgeon removes excess tissue, skin, and fat to reshape the breast, often aiming for symmetry with the other breast.If necessary, the surgeon revises the scar tissue around a breast implant.Drains may be placed, and the incisions are closed.
Revision of reconstructed breast (e.g., significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction). (Do not report 19380 in conjunction with 12031, 12032, 12034, 12035, 12036, 12037, 13100, 13101, 13102, 15877, 19316, 19318, 19370, for the same breast)
Example 1: A patient who underwent breast reconstruction with a latissimus dorsi flap experiences significant asymmetry and requires revision of the flap position and removal of excess tissue to achieve a more natural breast shape., A patient with an implant-based reconstruction develops capsular contracture and requires significant capsular revision combined with soft tissue excision to improve the appearance and feel of the breast., A patient who underwent a TRAM flap reconstruction has excess fat and skin in the reconstructed breast, requiring significant tissue removal and re-shaping of the flap to improve symmetry.
Documentation should include the reason for the revision, operative details (e.g., techniques used, amount of tissue removed, re-advancement or re-inset of flaps, capsular revision), and the final result of the procedure.
- Revenue Code: P1A - MAJOR PROCEDURE - BREAST
- Payment Status: Active
- Specialties:Plastic Surgery, Reconstructive Surgery
- Place of Service:Ambulatory Surgical Center, Hospital - Inpatient, Hospital - Outpatient