Overview of CPT Code 19294:Placement of implantable breast prosthesis
CPT Code 19294 refers to the surgical procedure for the placement of an implantable breast prosthesis, typically performed for breast reconstruction or augmentation.
When CPT Code 19294 is Used?
This procedure is indicated in various clinical scenarios.
- Breast reconstruction following mastectomy due to breast cancer.
- Cosmetic breast augmentation for patients seeking enhanced breast size.
- Correction of congenital breast deformities.
- Revision surgery for previous breast implant complications.
Symptoms Indicating This Procedure
Patients may present with specific symptoms that warrant this procedure.
- Desire for breast enhancement or restoration.
- Physical asymmetry in breast size.
- Post-mastectomy changes in breast appearance.
- Psychological distress related to breast appearance.
Causes and Risk Factors
Several factors may lead to the need for breast prosthesis placement.
- Breast cancer requiring mastectomy.
- Genetic predisposition to breast cancer.
- Congenital breast abnormalities.
- Previous breast surgeries leading to deformities.
Diagnostic Tests Before Procedure
Certain tests are essential to evaluate the patient's condition prior to surgery.
- Mammography to assess breast tissue.
- Ultrasound for imaging of breast abnormalities.
- MRI for detailed imaging in complex cases.
- Blood tests to evaluate overall health.
Procedure Description
The procedure involves several key steps.
- Administer anesthesia to ensure patient comfort.
- Make an incision in a discreet location.
- Create a pocket for the implant either under the breast tissue or beneath the chest muscle.
- Insert the breast prosthesis into the pocket.
- Close the incision with sutures and apply dressings.
Preparation for the Procedure
Patients should follow specific guidelines before the surgery.
- Consult with the surgeon to discuss expectations and risks.
- Avoid blood thinners and certain medications as advised.
- Arrange for transportation to and from the procedure.
- Follow pre-operative fasting instructions.
Recovery and Aftercare
Post-operative care is crucial for recovery.
- Expect swelling and discomfort for several days.
- Follow-up appointments to monitor healing.
- Wear a supportive bra as recommended.
- Avoid strenuous activities for a few weeks.
Possible Complications
As with any surgery, there are potential risks involved.
- Infection at the surgical site.
- Bleeding or hematoma formation.
- Capsular contracture around the implant.
- Implant rupture or leakage.
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Post-Procedure Follow-Up
Regular follow-up is essential for monitoring recovery.
- Initial follow-up within a week post-surgery.
- Subsequent visits at 1 month, 3 months, and 6 months.
- Annual check-ups to assess implant integrity.
Alternative Treatments
There are non-surgical options available for breast enhancement.
- Fat transfer breast augmentation.
- External breast prostheses for non-surgical options.
- Hormonal therapy for breast development in certain cases.
Home Care Tips
Patients can follow these tips for better recovery at home.
- Keep the surgical area clean and dry.
- Monitor for signs of infection such as redness or discharge.
- Take prescribed medications as directed.
- Rest and avoid heavy lifting during recovery.
Patient Education & Prevention
Understanding risks and preventive measures is important.
- Discuss family history of breast cancer with your doctor.
- Regular self-exams and mammograms as recommended.
- Healthy lifestyle choices to reduce cancer risk.
- Awareness of changes in breast appearance or sensation.
Billing and Coding Information
CPT Code: 19294
Category: Surgery
Common Modifiers:
- 50 - Bilateral procedure
- RT - Right side
- LT - Left side
Average Cost and Insurance Coverage
Costs can vary based on several factors.
- Average cost ranges from $5,000 to $10,000.
- Insurance may cover the procedure if medically necessary.
- Out-of-pocket costs depend on the insurance plan.
Related CPT Codes
- 19303 - Breast Reconstruction with Implant
- 19304 - Breast Reconstruction with Implant
- 19305 - Breast Reconstruction with Implant
- 19306 - Breast Reconstruction, Implant
- 19307 - Breast Reconstruction with Implant
References and Sources
Frequently Asked Questions (FAQs)
What is the recovery time for this procedure?
Most patients can return to normal activities within 4 to 6 weeks.
Will I have visible scars after surgery?
Scars will fade over time and can be placed in discreet locations.
Are breast implants safe?
Breast implants are generally safe, but they require monitoring.
Can I breastfeed after getting implants?
Many women can breastfeed after surgery, but consult your doctor.
