October 31, 2019
A patient had bilateral breast augmentation 5 weeks ago. She developed some drainage out of the lateral aspect of her left breast inframammary incision. The area was probed in the office with a Q-tip and it communicated with the implant pocket so I did a wash out of the left breast and replacement of the implant. We are charging the patient, not the insurance company, and my coder wants to use 19328 for the implant removal, 10060 for the washout, and 19325 for the new implant placement to determine our fee. I think my coder is unbundling and I should only charge my fee for 19325. What are your thoughts?
I agree with you to use only 19325 for your fee comparison. The removal (19328) is included in the new placement (19325) because you couldn’t put a new implant in unless the old one was removed. Also, the wound washout would not be separately reported.
*This response is based on the best information available as of 10/31/19.