What is the CPT code for a breast scar revision?
The Common Procedural Terminology (CPT) code for a breast scar revision can vary depending on the specific procedure performed and the extent of the revision. CPT codes are used in medical billing and coding to describe and classify medical procedures for insurance and billing purposes. To accurately code a breast scar revision, you would need to consider factors such as the technique used, the location of the scar, and whether it was a simple or complex revision.
Here are some commonly used CPT codes for breast scar revision procedures:
CPT code 11440: Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips; excised diameter over 4.0 cm.
CPT code 13160: Secondary closure of surgical wound or dehiscence, extensive or complicated.
CPT code 19380: Revision of reconstructed breast.
CPT code 19370: Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion.
CPT code 20926: Tissue grafts, other (e.g., paratenon, fat, dermis).
CPT code 20974: Allograft, includes templating, cutting, placement, and suturing of graft.
Please note that the appropriate CPT code for a specific breast scar revision should be determined by the healthcare provider or medical coder based on the details of the procedure performed. Additionally, insurance companies may have specific guidelines and requirements for billing, so it's essential to ensure accurate coding and documentation for reimbursement purposes. Always consult with a qualified medical coding specialist or healthcare professional for precise coding guidance in your specific case.
CPT Code for Breast Scar Revision: A Guide for Medical Billing
The CPT code for breast scar revision is 19380. This code is used for the revision of a reconstructed breast. It includes all necessary procedures to improve the appearance and function of the reconstructed breast, such as:
- Scar revision
- Flap readvancement
- Significant tissue removal
- Capsular revision with combined soft tissue excision in implant-based reconstruction
If the breast scar revision is a limited procedure, such as just the scar revision and has a defined code, then the more specific code should be used instead of 19380.
Understanding Surgical Coding: CPT Codes for Scar Revision
CPT codes are used to report medical procedures and services to insurance companies. CPT codes are published by the American Medical Association (AMA) and are updated annually.
CPT codes are divided into three sections:
- Section 1: Evaluation and Management Codes
- Section 2: Surgery Codes
- Section 3: Radiology Codes
Scar revision codes are found in Section 2 of the CPT codebook. The CPT code for breast scar revision is 19380.
Billing and Insurance Reimbursement for Breast Scar Revision Procedures
When billing for a breast scar revision procedure, the provider should include the following information on the claim form:
- The patient's name and date of birth
- The date of service
- The CPT code for the procedure
- The diagnosis code for the reason for the procedure
- The provider's name and National Provider Identifier (NPI) number
The provider should also attach any necessary documentation to the claim form, such as a surgical report or operative notes.
The amount of reimbursement for a breast scar revision procedure will vary depending on the insurance company and the patient's plan. The provider should check with the insurance company to verify the patient's coverage and benefits before performing the procedure.
Here are some additional tips for billing for breast scar revision procedures:
- Use the most specific CPT code that accurately describes the procedure performed.
- Attach all necessary documentation to the claim form.
- Check with the insurance company to verify the patient's coverage and benefits before performing the procedure.
If you have any questions about billing for breast scar revision procedures, you should consult with a qualified medical billing and coding professional.
