2025 CPT code 19369
(Active) Effective Date: N/A Revision Date: N/A Surgery - Breast Reconstruction Surgery Feed
Breast reconstruction using a bipedicled transverse rectus abdominis myocutaneous (TRAM) flap.
Modifiers 50 (Bilateral Procedure), 51 (Multiple Procedures), and potentially others depending on the circumstances of the procedure.
Medical necessity for breast reconstruction with a bipedicled TRAM flap is typically established by the patient's desire for breast restoration following mastectomy or other breast surgeries resulting in significant tissue loss.The procedure is considered medically necessary if it addresses a significant cosmetic deformity or functional impairment resulting from the underlying condition.
The surgeon's responsibilities include pre-operative planning, surgical technique, post-operative care, and management of complications.This may also include coordination with other specialists such as oncologists, plastic surgeons, and anesthesiologists.
In simple words: The surgeon creates a new breast by taking skin, fat, and muscle from both sides of the lower belly.This tissue is moved to the chest to form a new breast, leaving the blood supply to the moved tissue intact. The belly area is then closed.
This procedure involves harvesting skin, subcutaneous fat, and both rectus abdominis muscles from the lower abdomen for single breast reconstruction.The dual blood supply to the flap remains attached to its origins in the abdomen. The flap is then transposed to the chest and sculpted to create a new breast mound.The procedure includes harvesting the flap, closure of the donor site, insetting, and shaping the flap.
Example 1: A patient undergoes a mastectomy for breast cancer and elects for immediate breast reconstruction using a bipedicled TRAM flap. This is chosen because of ample abdominal tissue and the desire to avoid implants., A patient has undergone a prior mastectomy and desires delayed reconstruction.A bipedicled TRAM flap is selected due to sufficient abdominal tissue and the surgeon's preference for autologous tissue reconstruction., A patient has undergone a previous unilateral TRAM flap breast reconstruction and now desires reconstruction of the contralateral breast. A bipedicled TRAM flap is selected due to adequate tissue and symmetry goals.
* Operative report detailing the procedure, including flap harvest, transfer, inset, and donor site closure.* Preoperative imaging (e.g., mammogram, MRI) to assess breast tissue and abdominal tissue.* Photographs documenting the pre-operative and post-operative appearance of the breasts.* Pathology report if any tissue is removed.* Patient history including previous surgeries.
** The selection of a bipedicled TRAM flap depends on several factors, including the patient's anatomy, the extent of tissue loss, and surgeon preference.Careful assessment of the patient's abdominal wall is crucial to ensure adequate tissue and avoid complications.
- Revenue Code: P1A (Major Procedure - Breast)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Plastic Surgery, Surgical Oncology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center