Help - breast reconstruction coding

Provider does open periprosthetic capsulotomy 19370 w/ removal of expander exhcange w/ permanent prosthesis 11970.
bcbs denies the expander as inclusive. Are the two procedures typically bundled? Or should I append mod 59. Some ins companies pay the two together.
thanks.

re: HELP - BREAST RECONSTRUCTION CODING

A straightforward exchange of expander to permanent prosthesis is coded as 11970. A capsulotomy is included in 11970 when performed to make the exchange - the capsule must be opened to take out the expander and put in the prosthesis. The ASPS coding course is a good resource. http://www.plasticsurgery.org/For-Medical-Professionals/Resources-and-Education/Meetings/Coding-Workshops-2011-.html

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com

re: HELP - BREAST RECONSTRUCTION CODING

Thanks for your help.