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The procedure described by CPT® Code 19368 involves breast reconstruction utilizing a single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, which necessitates a separate microvascular anastomosis, commonly referred to as supercharging. This surgical technique is typically performed to restore the breast's shape and appearance following a mastectomy, either immediately after the removal of breast tissue or at a later date after the completion of other treatments. The TRAM flap is composed of skin, fat, and muscle that are harvested from the abdominal area and then transplanted to the chest to create a new breast mound. Prior to the procedure, the abdomen is marked while the patient is in a standing position to ensure optimal flap design and vascular supply. An incision is made along these markings, extending down to the aponeurotic plane of the abdominal muscles. The surgical approach is designed to preserve the superior epigastric artery, which is crucial for maintaining blood flow to the flap. During the flap harvesting process, careful dissection is performed to minimize damage to the nerves and arteries, thereby preserving muscle function post-surgery. The dissection continues upward towards the xiphoid process and laterally to the oblique muscles, creating a tunnel that allows for the flap to be transferred to the chest area. A circular incision is made around the umbilicus to detach the umbilical pedicle from the flap, and further dissection is carried out along the pubic region. Depending on the reconstruction needs, either one or both rectus muscles may be harvested, ensuring that only the necessary tissue is taken to maintain adequate blood supply. Once the flap is prepared, it is rotated into position on the chest, where it can be shaped to achieve a natural breast contour. The procedure may involve microvascular anastomosis to enhance blood flow, particularly by connecting the inferior epigastric artery to nearby blood vessels. After ensuring proper blood circulation to the flap, the surgical team secures the flap in place, closes the chest incisions, and places drains to manage fluid accumulation. The abdominal incision is also closed, often with reinforcement of the abdominal muscles using mesh if both rectus muscles were utilized. Finally, the umbilicus is repositioned and secured, and the skin incisions are closed to complete the reconstruction process.
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The procedure described by CPT® Code 19368 is indicated for patients requiring breast reconstruction following mastectomy. The specific indications include:
The procedure for CPT® Code 19368 involves several detailed steps to ensure successful breast reconstruction using a single-pedicled TRAM flap:
Post-procedure care following the TRAM flap breast reconstruction involves monitoring for complications and ensuring proper healing. Patients can expect to have drains placed to manage fluid accumulation, which will be monitored and removed as necessary. Recovery may involve pain management and physical therapy to regain strength and mobility in the abdominal area. The surgical team will provide specific instructions regarding activity restrictions, wound care, and follow-up appointments to assess healing and the cosmetic outcome of the reconstruction. Patients may also require additional procedures, such as liposuction or skin tailoring, to optimize the aesthetic appearance of the reconstructed breast(s).
| Short Descr | BRST RCNSTJ 1PDCL TRAM ANAST | Medium Descr | BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST | Long Descr | Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, requiring separate microvascular anastomosis (supercharging) | 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 |
| 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). | 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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) |
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| 2021-01-01 | Changed | Code changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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