Medical Billing · Nationwide
Complex Adult Reconstructive Microsurgery & Autologous DIEP Flap Breast Reconstruction Medical Billing Services
Advanced autologous microvascular post-mastectomy breast reconstruction: deep inferior epigastric perforator (DIEP) free flap harvest with microvascular anastomosis to internal mammary recipient vessels (CPT 19364), operating microscope add-on (+69990), indocyanine green (ICG) laser fluorescence angiography (+15860), second venous coupling (+35201), and bilateral symmetry reconstruction.
Aethera Healthcare Solutions provides full-service medical billing and revenue cycle management to plastic and reconstructive microsurgeons, surgical oncologists, autologous breast reconstructive teams, and comprehensive cancer institutes across the United States. We handle coding, claims, payment posting, denial management, and A/R follow-up end to end — so your team can stay focused on patient care while your revenue cycle runs cleanly.
Typical complex adult reconstructive microsurgery & autologous diep flap breast reconstruction CPT range we work: 19364, 15756, 15757, 19357, 15860, 69990, 35201, 35206, 99223, 99233.
Why complex adult reconstructive microsurgery & autologous diep flap breast reconstruction billing leaks revenue
Bilateral DIEP flap (19364-50) fee reduction and downcoding: Commercial payers downcoding bilateral free flaps to pedicled TRAM flaps or rejecting bilateral modifier billing
Operating microscope (+69990) unbundling denials: Inappropriate denial of high-power microvascular magnification during 1mm–2mm arterial and venous coupler anastomoses
Indocyanine green (ICG) angiography (+15860) coverage disputes: Health plans denying intraoperative perfusion imaging as experimental or inclusive to flap transfer
Second venous anastomotic rescue (+35201/+35206) clawbacks: Disallowance of additional venous outflow anastomoses performed to prevent microvascular flap congestion
How Aethera fixes it
Specialty-trained coders (CPC/CCS) code to the documentation
First-pass claim scrubbing against payer and NCCI edits
Proactive denial prevention and 72-hour denial work
Relentless A/R follow-up to drive days-in-A/R down
Eligibility and prior-auth verification before service
Transparent, real-time reporting in the provider portal
Free tools for your billing team
Use these any time — no login required.
Complex Adult Reconstructive Microsurgery & Autologous DIEP Flap Breast Reconstruction billing FAQ
How should bilateral DIEP flap breast reconstructions be coded under federal WHCRA guidelines?
Under the Women’s Health and Cancer Rights Act (WHCRA) and CPT coding guidelines, autologous free DIEP flap reconstruction is reported using CPT 19364 (breast reconstruction; with other than muscle-sparing free flap of lower abdomen). For bilateral reconstructions, surgeons should report CPT 19364-50 (or 19364-RT and 19364-LT depending on payer modifier rules). Each breast represents an independent microvascular harvest, transfer, and dual-vessel anastomosis requiring dedicated operative documentation.
Is the operating microscope (+69990) separately billable with free flap breast reconstruction (CPT 19364)?
Yes. Under CMS NCCI Chapter VIII guidelines, CPT 19364 does not include the operating microscope. Add-on code +69990 is fully reportable when the operating microscope is utilized for microvascular dissection and micro-arterial/venous anastomoses (e.g. 9-0 or 10-0 nylon sutures under 10x–16x magnification), distinct from surgical loupes.