CPT code 19328 is for the removal of an intact breast implant.
CPT code 19328 is used to describe the procedure for the removal of an intact breast implant. This code is typically utilized when a patient requires the removal of a breast implant that has not ruptured or leaked. The procedure involves surgically extracting the implant from the breast pocket, often due to reasons such as implant malfunction, patient discomfort, or a decision to change the size or type of implant. This code is essential for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the services rendered.
When dealing with CPT code 19328 for the removal of an intact breast implant, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Used when the removal of intact breast implants is performed on both breasts during the same operative session.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures, including the removal of intact breast implants, are performed during the same surgical session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Used if the removal of the breast implant is part of a planned, staged procedure or is related to the initial surgery and performed during the postoperative period.
4. Modifier 59 - Distinct Procedural Service
- Indicates that the removal of the breast implant is a distinct procedure from other services provided on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Applied when the same procedure is repeated by the same physician or healthcare professional.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when the same procedure is repeated by a different physician or healthcare professional.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when the removal of the breast implant is unrelated to the original procedure and occurs during the postoperative period.
9. Modifier 80 - Assistant Surgeon
- Applied when an assistant surgeon is required during the removal of the breast implant.
10. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate reimbursement and documentation for the removal of intact breast implants.
The CPT code 19328, which pertains to the removal of an intact breast implant, is reimbursed by Medicare under specific conditions. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. Additionally, the Medicare Administrative Contractor (MAC) for your region may have specific guidelines and coverage criteria that must be met for reimbursement. It is essential to consult the MPFS and your local MAC to ensure compliance with all necessary requirements and to verify the exact reimbursement details for CPT code 19328.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving accurate reimbursements for procedures like CPT code 19328. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
