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The procedure described by CPT® Code 19367 involves breast reconstruction utilizing a single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap. This surgical technique is designed to restore the shape and appearance of the breast following mastectomy, which may be performed either immediately after the mastectomy or at a later date, depending on the patient's treatment plan. The TRAM flap is composed of skin, fat, and muscle tissue that is harvested from the abdominal area and then transplanted to the chest to create a new breast mound. The procedure begins with the patient standing, allowing for precise marking of the abdomen to optimize the flap's vascular supply. An incision is made along these markings, carefully dissecting down to the aponeurotic plane of the abdominal muscles. The surgical team takes special care to preserve the superior epigastric artery, which is crucial for maintaining blood flow to the flap. The dissection continues to ensure that the flap is adequately sized and shaped for successful transplantation, while also minimizing disruption to the abdominal muscles to preserve function. The final steps involve securing the flap in place on the chest, ensuring proper blood flow, and closing the incisions in a manner that promotes healing and aesthetic outcomes.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 19367 is indicated for patients requiring breast reconstruction following mastectomy. The specific indications include:
The procedure for breast reconstruction using a single-pedicled TRAM flap involves several detailed steps:
Post-procedure care following a TRAM flap breast reconstruction includes monitoring for complications such as infection or flap failure. Patients are typically advised to rest and limit physical activity to promote healing. Drain management is essential to prevent fluid accumulation at the surgical site. Follow-up appointments are necessary to assess the healing process and the viability of the flap. Additional cosmetic procedures, such as liposuction or skin tailoring, may be considered to enhance the aesthetic outcome. The relocated umbilicus will also be monitored for proper healing and positioning.
| Short Descr | BRST RCNSTJ 1 PDCL TRAM FLAP | Medium Descr | BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP | Long Descr | Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1A - Major procedure - breast | MUE | 1 | 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). | 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. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service |
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| 2021-01-01 | Changed | Code changed. |
| 2010-01-01 | Changed | Code description changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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