Ask Dr. Z

A clamshell incision for chest and mediastinal exploration (bilateral anterolateral thoracotomy with transverse sternotomy) and intrapericardial pneumonectomy with resection of large tumor mass are performed along with bilateral explant and reimplant of breast prosthesis because of where the anterolateral incision had to be made for exposure. Are the explant/reimplant of breast prosthesis procedures separately billable, or are they bundled into the mediastinal exploration with intrapericardial pneumonectomy procedures?

"Due to size of tumor and extension into mediastinum, clamshell incision was performed. The breast prosthesis pocket was extended and was actually opened bilaterally because of where the anterolateral incision had to be made for exposure. Pocket was opened, and breast prosthesis was removed and re-implanted at the end of the clamshell incision for left chest and mediastinal exploration (bilateral anterolateral thoracotomy with transverse sternotomy) and intrapericardial pneumonectomy with resection of large tumor mass procedures."