Overview of CPT Code 19367: Breast Reconstruction with Implant

Overview of CPT Code 19367: Breast Reconstruction with Implant

CPT Code 19367 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 19367 is Used?

This procedure is indicated in various clinical scenarios, including:

• Post-mastectomy breast reconstruction for patients who have undergone total or partial mastectomy due to breast cancer.
• Reconstruction after lumpectomy when significant breast tissue has been removed.
• Reconstruction for congenital breast deformities or asymmetry.
• Reconstruction following trauma or injury to the breast.

Symptoms Indicating This Procedure

Patients may report the following symptoms or concerns that lead to the consideration of this procedure:

• Loss of breast shape or volume after mastectomy.
• Psychological distress related to body image post-surgery.
• Desire for symmetry in breast appearance.
• Physical discomfort or dissatisfaction with the current breast appearance.

Causes and Risk Factors

Several factors may lead to the need for breast reconstruction, including:

• Breast cancer diagnosis requiring mastectomy.
• Genetic predisposition to breast cancer (e.g., BRCA mutations).
• Previous breast surgeries that resulted in deformity.
• Radiation therapy to the breast area that may affect tissue integrity.

Diagnostic Tests Before Procedure

Before undergoing breast reconstruction, several diagnostic tests may be performed:

• Mammography to assess breast tissue health.
• MRI or ultrasound to evaluate breast tissue and detect abnormalities.
• Blood tests to assess overall health and suitability for surgery.

Procedure Description

The breast reconstruction procedure typically involves the following steps:

• Anesthesia is administered to ensure patient comfort.
• An incision is made in the breast area, following the natural contours.
• The implant is placed either directly under the breast tissue or under the chest muscle.
• The incision is closed with sutures, and dressings are applied.
• Post-operative monitoring is conducted to ensure recovery.

Preparation for the Procedure

Patients should follow these steps to prepare for breast reconstruction:

• Consult with the surgeon to discuss expectations and outcomes.
• Stop smoking and avoid blood-thinning medications as advised.
• Arrange for post-operative care and transportation home.
• Follow any specific dietary restrictions prior to surgery.

Recovery and Aftercare

Recovery from breast reconstruction typically involves:

• A recovery period of 4 to 6 weeks, with gradual return to normal activities.
• Wound care instructions to keep the surgical site clean and dry.
• Pain management with prescribed medications as needed.
• Follow-up appointments to monitor healing and implant placement.

Possible Complications

As with any surgical procedure, there are potential risks, including:

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Implant complications such as rupture or displacement.
• Scarring or changes in breast sensation.

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Post-Procedure Follow-Up

Follow-up care is essential for monitoring recovery:

• Initial follow-up 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 in breast appearance.

Alternative Treatments

Patients may consider these non-surgical options:

• Prosthetic breast forms for temporary solutions.
• Counseling or support groups for emotional support.
• Physical therapy to address any post-surgical mobility issues.

Home Care Tips

To aid recovery at home, patients should consider the following:

• Keep the surgical area clean and dry.
• Wear a supportive bra as recommended by the surgeon.
• Avoid strenuous activities and heavy lifting for several weeks.
• Stay hydrated and maintain a balanced diet to promote healing.

Patient Education & Prevention

To prevent complications and promote health:

• Understand the signs of infection and when to seek help.
• Regular breast self-exams and follow-up screenings.
• Discuss genetic testing options if there is a family history of breast cancer.

Billing and Coding Information

CPT Code: 19367

Category: Surgery

Common Modifiers:

• 50 (bilateral procedure)
• RT (right side)
• LT (left side)

Average Cost and Insurance Coverage

The cost of breast reconstruction can vary widely:

• Average costs range from $7,000 to $15,000 depending on complexity.
• Most insurance plans cover breast reconstruction after mastectomy.
• Patients should verify coverage details with their insurance provider.

Related CPT Codes

• 19361 - Breast Reconstruction with Implant
• 19368 - Breast Reconstruction with Tissue Expander
• 19369 - Breast Reconstruction with Implant
• 19370 - Breast Reconstruction with Tissue Expander
• 19380 - Breast Reconstruction, Unilateral

References and Sources

• American Society of Plastic Surgeons
• National Cancer Institute
• Breastcancer.org