Overview of CPT Code 19304: Breast Reconstruction with Implant
CPT Code 19304 refers to the surgical procedure of breast reconstruction using an implant following mastectomy or breast tissue removal. This procedure aims to restore the breast's shape and appearance, enhancing the patient's body image and self-esteem.
When CPT Code 19304 is Used?
This procedure is indicated in various clinical scenarios, including:
- Post-mastectomy breast reconstruction for breast cancer patients.
- Reconstruction after lumpectomy when significant breast tissue is removed.
- Congenital breast deformities requiring reconstruction.
- Trauma or injury to the breast necessitating reconstruction.
Symptoms Indicating This Procedure
Patients may report the following symptoms or clinical findings:
- Loss of breast shape or volume after mastectomy.
- Asymmetry in breast appearance post-surgery.
- Psychological distress related to body image.
- Desire for restoration of breast aesthetics.
Causes and Risk Factors
Several factors may lead to the need for breast reconstruction:
- Breast cancer diagnosis requiring mastectomy.
- Genetic predisposition to breast cancer (e.g., BRCA mutations).
- Previous breast surgeries that altered breast structure.
- Radiation therapy affecting breast tissue.
Diagnostic Tests Before Procedure
Prior to the procedure, the following diagnostic tests may be performed:
- Mammography to assess breast tissue.
- MRI for detailed imaging of breast anatomy.
- Ultrasound to evaluate any abnormalities.
- Blood tests to assess overall health and surgical risk.
Procedure Description
The breast reconstruction procedure typically involves the following steps:
- Anesthesia administration to ensure patient comfort.
- Incision made in the breast area, often following the mastectomy scar.
- Creation of a pocket for the implant beneath the chest muscle.
- Insertion of the breast implant into the pocket.
- Closure of the incision with sutures and application of dressings.
Preparation for the Procedure
Patients should follow these preparation steps:
- Consult with the surgeon to discuss expectations and risks.
- Avoid blood thinners and certain medications as advised.
- Arrange for post-operative transportation and care.
- Follow pre-operative fasting instructions.
Recovery and Aftercare
Post-operative recovery typically includes:
- Initial recovery period of 1 to 2 weeks.
- Wound care instructions to keep the incision clean.
- Pain management with prescribed medications.
- Gradual return to normal activities as advised by the surgeon.
Possible Complications
Patients should be aware of potential complications, including:
- Infection at the surgical site.
- Implant rupture or leakage.
- Capsular contracture (hardening around the implant).
- Changes in breast sensation.
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Post-Procedure Follow-Up
Follow-up care is essential for monitoring recovery:
- Initial follow-up appointment within 1 to 2 weeks post-surgery.
- Regular check-ups every few months for the first year.
- Long-term monitoring for any complications or changes.
Alternative Treatments
Non-surgical options may include:
- Prosthetic breast forms for temporary restoration.
- Psychological counseling for body image issues.
- Physical therapy to improve post-surgical mobility.
Home Care Tips
Patients can follow these tips for better recovery:
- Keep the surgical area clean and dry.
- Wear a supportive bra as recommended.
- Avoid heavy lifting and strenuous activities.
- Stay hydrated and maintain a balanced diet.
Patient Education & Prevention
To prevent complications and recurrence:
- Regular breast screenings and self-exams.
- Awareness of family history and genetic factors.
- Healthy lifestyle choices to reduce cancer risk.
Billing and Coding Information
CPT Code: 19304
Category: Surgical Procedures
Common Modifiers:
- 50
- RT
- LT
Average Cost and Insurance Coverage
Costs can vary widely based on several factors:
- Average cost ranges from $7,000 to $15,000.
- Insurance may cover the procedure if deemed medically necessary.
- Out-of-pocket costs depend on the insurance plan and coverage.
Related CPT Codes
- 19303 - 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 breast reconstruction with an implant?
It is a surgical procedure to restore the shape of the breast after mastectomy using an implant.
How long does the recovery take?
Most patients can expect a recovery period of 1 to 2 weeks.
Will insurance cover this procedure?
Insurance often covers breast reconstruction if it is deemed medically necessary.
Are there risks associated with the procedure?
Yes, potential risks include infection, implant complications, and changes in sensation.
What should I do to prepare for surgery?
Follow your surgeon's instructions, avoid certain medications, and arrange for post-operative care.
