Denial On Breast Reconstruction Code

Denial On Breast Reconstruction Code

November 11, 2021

My doctor removed a tissue expander and placed a permanent implant. He made some minor adjustments so we billed 19342. The payor asked for the operative note so we sent it. Then we got a denial. I’m trying to figure out why 19342 would be denied.

Good question and this issue is a result of a CPT code change in 2021. Prior to 2021, there were two codes available for removing a tissue expander and placing a permanent implant depending on the extent of the dissection and capsule modification. However, in 2021, there is only one code for the service you describe – 11970.

*This response is based on the best information available as of 11/11/21.




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