Overview of CPT Code 19301: Breast Reconstruction, Unilateral
CPT Code 19301 refers to the surgical procedure of breast reconstruction performed on one side of the body, typically following a mastectomy due to breast cancer or other medical conditions.
When CPT Code 19301 is Used?
This procedure is indicated in several clinical scenarios.
- Unilateral mastectomy due to breast cancer.
- Breast tissue loss due to trauma or congenital deformities.
- Reconstruction after lumpectomy with significant tissue loss.
Symptoms Indicating This Procedure
Patients may report various symptoms leading to the need for this procedure.
- Loss of breast contour or volume.
- Psychological distress related to breast loss.
- Physical discomfort or asymmetry.
Causes and Risk Factors
Several factors can lead to the need for unilateral breast reconstruction.
- Breast cancer requiring mastectomy.
- Genetic predisposition to breast cancer.
- Previous breast surgeries or trauma.
Diagnostic Tests Before Procedure
Certain tests are essential to evaluate the patient's condition before surgery.
- Mammography to assess breast tissue.
- MRI for detailed imaging of breast anatomy.
- Biopsy to confirm cancer diagnosis.
Procedure Description
The procedure involves several key steps.
- Anesthesia administration.
- Incision made in the breast area.
- Tissue expansion or flap technique used for reconstruction.
- Closure of incisions with sutures.
Preparation for the Procedure
Patients should follow specific guidelines to prepare for surgery.
- Consultation with the surgeon to discuss expectations.
- Pre-operative imaging and tests as required.
- Avoiding blood thinners and certain medications prior to surgery.
Recovery and Aftercare
Post-operative care is crucial for recovery.
- Initial recovery period of 4-6 weeks.
- Wound care instructions to prevent infection.
- Pain management with prescribed medications.
Possible Complications
As with any surgery, there are potential risks involved.
- Infection at the surgical site.
- Scarring or changes in breast sensation.
- Complications related to anesthesia.
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Post-Procedure Follow-Up
Regular follow-up is essential for monitoring recovery.
- Initial follow-up within 1-2 weeks post-surgery.
- Subsequent visits every few months for the first year.
- Long-term monitoring for any complications.
Alternative Treatments
There are non-surgical options available for breast reconstruction.
- Prosthetic breast forms.
- Fat grafting techniques.
- Psychological counseling for emotional support.
Home Care Tips
Patients can follow these tips for better recovery at home.
- Keep the surgical area clean and dry.
- Wear a supportive bra as advised.
- Avoid strenuous activities until cleared by the doctor.
Patient Education & Prevention
Education is key to preventing complications and recurrence.
- Understanding the signs of infection.
- Regular breast self-exams and follow-up screenings.
- Healthy lifestyle choices to reduce cancer risk.
Billing and Coding Information
CPT Code: 19301
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 $10,000 to $30,000.
- Most insurance plans cover the procedure if medically necessary.
- Out-of-pocket costs depend on the insurance policy.
Related CPT Codes
- 19302 - Breast Reconstruction with Implant
- 19303 - Breast Reconstruction with Implant
- 19304 - Breast Reconstruction with Implant
- 19305 - Breast Reconstruction with Implant
- 19306 - Breast Reconstruction, Implant
References and Sources
Frequently Asked Questions (FAQs)
What is unilateral breast reconstruction?
It is a surgical procedure to rebuild one breast after mastectomy.
How long does recovery take?
Recovery typically takes 4-6 weeks, depending on individual healing.
Will insurance cover this procedure?
Most insurance plans cover it if deemed medically necessary.
Are there risks involved?
Yes, like any surgery, there are risks such as infection and scarring.
What should I expect during the procedure?
You will receive anesthesia, and the surgeon will reconstruct the breast using various techniques.
