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The procedure described by CPT® Code 11970 involves the surgical replacement of a tissue expander with a permanent implant. A tissue expander is a device used in reconstructive surgery to stretch the skin and create additional tissue for later use, often in breast reconstruction. In this procedure, the physician first deflates the existing tissue expander to facilitate its removal. An incision is made at the site of the expander, allowing the surgeon to carefully extract the device. Once the tissue expander is removed, a permanent implant, which is selected based on the appropriate size for the patient's needs, is inserted into the same location. The implant is then stabilized to ensure proper positioning and function. Finally, the incision is closed, completing the procedure. This code is distinct from CPT® Code 11971, which involves the removal of a tissue expander without the insertion of a permanent implant or another expander, highlighting the specific nature of the surgical intervention associated with CPT® Code 11970.
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The procedure represented by CPT® Code 11970 is indicated for patients who have previously undergone tissue expansion and are ready to transition to a permanent implant. This may include individuals who have had breast reconstruction following mastectomy or other reconstructive surgeries where tissue expansion was utilized to create sufficient skin and tissue for the placement of a permanent prosthetic. The procedure is typically performed when the tissue expander has served its purpose, and the patient is prepared for the next step in their reconstructive journey.
The procedure begins with the physician deflating the existing tissue expander. This step is crucial as it reduces the volume of the expander, making it easier to remove. Following deflation, an incision is made at the site of the tissue expander. The surgeon carefully dissects the surrounding tissue to access the expander, ensuring minimal trauma to the surrounding areas. Once the expander is fully exposed, it is gently removed from the surgical site. After the expander is taken out, the surgeon selects a permanent implant that is appropriate in size for the patient’s anatomy and reconstructive goals. The permanent implant is then inserted into the same space previously occupied by the tissue expander. The surgeon ensures that the implant is properly positioned and stabilized to prevent any movement or complications. Finally, the incision is meticulously closed, often using sutures, to promote optimal healing and minimize scarring.
After the procedure, patients may be monitored for any immediate complications related to the surgery. Post-operative care typically includes instructions on wound care, activity restrictions, and signs of potential complications such as infection or implant displacement. Patients may also be advised on pain management strategies and follow-up appointments to assess healing and the condition of the implant. In some cases, a drain may be placed in the surgical site to prevent fluid accumulation, which will be removed at a later follow-up visit. Overall, the recovery process will vary based on individual circumstances, but patients are generally encouraged to follow their surgeon's specific post-operative guidelines to ensure optimal recovery.
| Short Descr | RPLCMT TISS XPNDR PERM IMPLT | Medium Descr | REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT | Long Descr | Replacement of tissue expander with permanent implant | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 2 | CCS Clinical Classification | 175 - Other OR therapeutic procedures on skin and breast |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | RT | Right side (used to identify procedures performed on the right side of the body) | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | SG | Ambulatory surgical center (asc) facility service | LT | Left side (used to identify procedures performed on the left side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2021-01-01 | Changed | Code changed. |
| Pre-1990 | Added | Code added. |
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