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2025 CPT code 19370

Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy.

Refer to CPT coding guidelines for breast procedures and implant revisions for correct application of 19370.

Modifiers may be applicable in certain situations. For example, modifier 50 would be used for bilateral procedures.

Medical necessity for 19370 must be established by documenting the patient's symptoms related to capsular contracture or implant malposition, impacting their quality of life or physical function.Pain, tightness, asymmetry, or other complications should be clearly noted.

The physician performs the surgical revision of the breast implant capsule. This includes prepping and anesthetizing the patient, making the incision, releasing or removing scar tissue, repositioning the implant if necessary, achieving hemostasis, and closing the incision.

IMPORTANT:Do not report 19370 in conjunction with 19328 for removal and replacement of the same implant to access the capsule. For removal and replacement with a new implant, use 19342.

In simple words: This procedure involves correcting issues with the scar tissue that forms around a breast implant. The surgeon goes in through the existing scar, releases the tight scar tissue, and may remove some of it or reposition the implant to improve comfort and appearance.

Surgical release of scar tissue (capsule) around a breast implant to relieve pain from capsular contracture or to correct implant malposition.This may involve incising the breast tissue, releasing the scar tissue, removing part of the capsule, and/or repositioning the implant.The procedure is completed by closing the operative site in layers.

Example 1: A patient with a previous breast implant experiences pain and tightness due to capsular contracture. The physician performs a capsulotomy (19370) to release the constricting scar tissue., A patient's breast implant has shifted out of place. The physician performs a capsulorrhaphy (19370) to reposition the implant and repair the surrounding capsule., A patient has a thickened, painful capsule around their breast implant. The physician performs a partial capsulectomy (19370) to remove a portion of the scar tissue.

Documentation should include details of the patient's symptoms (pain, tightness, implant malposition), the surgical approach used (capsulotomy, capsulorrhaphy, capsulectomy), the extent of the procedure (partial or complete), and any implant repositioning performed. Pre- and postoperative implant position should be documented with photos.

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