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Tag Archives: breast

Please help! – Breast–IRRIGATION & DEBRIDEMENT BREAST WOUND / ABSCESS

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Hello, which debridement code should I use along with implant removal code?

Operative Procedure: A 3.5 cm diameter circle at her mastectomy scar, and a 2.5 cm diameter circle superiorly where her tissue expander port site was previously located. Her implant is grossly visible at both of these locations. There is a thin intervening skin bridge connecting these 2 locations. With her consent a photo was taken in preoperative holding area and scanned into media prior to surgery. The skin bridge is clearly not viable and it is incised. The implant is removed and sent to pathology for gross examination. The implant pocket is then copiously irrigated with 3 L of pulse lavage saline. There is an inflammatory rind evident in the pocket. However there is no gross purulence. At the level of the prepectoral plane under direct visualization using cautery the skin flaps are elevated circumferentially. Using a 15 blade the skin edges were then debrided to remove the circular skin defects which leads to a vertical defect measuring 11 cm her left chest wall. The skin edges do bleed with this tissue removed. The mastectomy skin is sent to pathology for examination. 30 cc of quarter percent Marcaine with 1:100,000 epinephrine is injected for local anesthetic and hemostasis. With the wide undermining I am able to close the skin flaps with only minimal tension. Hemostasis is achieved using cautery. Saline was used for additional irrigation. A 10 French round JP drain is placed within the pocket. 3-0 Vicryl sutures were used to reapproximate the dermis. 4-0 Monocryl horizontal mattress sutures were used to loosely reapproximate the skin edges. A 13 cm Prevena incisional wound VAC is placed over the incision. A drain sponges placed around the drain site. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
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thank you :)

Medical Billing and Coding Forum

Help with Breast Excision Op Note Please

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Can anyone give any guidance for this. Thinking 19281 or 19125 or both??

Indications: This patient has a papilloma and mass of the of the right breast which was previously biopsied and requires excision.

Pre-operative Diagnosis: right breast mass and papilloma
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Post-operative Diagnosis: right breast mass and papilloma
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Procedure Details
The patient was seen in the Holding Room. The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The possibilities of reaction to medication, pulmonary aspiration, bleeding, infection, the need for additional procedures, failure to diagnose a condition, and creating a complication requiring transfusion or operation were discussed with the patient. The patient concurred with the proposed plan, giving informed consent. The site of surgery properly noted/marked. The patient was taken to operating room identified correctly and the procedure verified as right Needle localized Breast mass Excision. A Time Out was held and the above information confirmed.
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The patient was placed prone on the stereotactic core table. The right breast clip lesion was localized stereotactically. Using standard aseptic technique and 1% Lidocaine and for local anesthetic. A 9cm Kopans needle wire device was then advanced ot the targeting coordinates. Stereotactic imaging was used to confirm appropriate localization. The wire was deployed and imaging confirmed appropriate wire placement. Sterile dressing was placed with steristrips and gauze. The patient tolerated this procedure well without complications. She was then brought to the OR.
The patient was placed supine. The breast was prepped and draped in the standard fashion. Lidocaine 0.5% with epinephrine and bicarbonate was used to anesthetize the skin over the external portion of the wire.

An curvilinear incision was created at 8-10:00 in the periareolar skin near the external wire. Dissection was carried down through the subcutaneous fat. A core of breast tissue was taken around the wire and excised. The specimen was then imaged and the clip was confirmed to be in the tissue. Hemostasis was achieved with cautery. Closure was performed in 2 layers with a 4-0 monocrylsubcuticular closure. The specimen was oriented with sutures- short superior,long lateral.
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Steri-Strips were applied. At the end of the operation all sponge, instrument and needle counts were correct. interpreted all images during the procedure.
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Medical Billing and Coding Forum

Breast Reconstruction Help

Posted on by
I am having a lot of claims denied for breast recontruction. Below is a typical Claim

19342-50
19370-50,59
19301-50,59

And the notes…

"She had inferior transverse mastectomy scars which I planned to resect, so the incision was made just superior to these along the edge of the scar. This was made after infiltration of Marcaine with epinephrine. This was carried down through the AlloDerm layer after the subcutaneous layer. The AlloDerm was opened with cautery, and then sharply taking care not to damage the underlynig implant. Examination of the capsules revealed that they were thin, but without pericapsular fluid or capsular masses. Implants were intact. They were removed and placed in triple antibiotic baths.

The above described capsular manipulations were performed. This was very extensive capsular manipulation. Capsulotomies were made to allow the implant to move superomedial and these were made with extended cautery and fiberoptic lighted retractor carefully taking care not to divide any pec major muscle and to make the edges smooth for realistic result.

The capsulorrhaphies were to correct the stretched out pockets inferiorly and laterally. These were performed with floor advancement technique using a double-row capsulotomy and suturing these with 3-0 PDS buried. This was done inferiorly and laterally in a long continuous row. In addition, cautery capsulorrhaphies were performed using forceps and cautery to further tighten these very loose inferolateral pockets. Once the pockets were noted to be symmetric and hemostasis was obtained, the pockets were washed a final time with triple antibiotic solution. The implants looked excellent, so they were replaced. The AlloDenn layer was closed with buried 3-0 PDS suture taking bites through the subcutaneous tissue to cover the AlloDerm."

I have tried to let the provider know that his documentation is insufficient for the 19370 and 19301. Any Suggestions about how I could advise him to make his notes better?

Thanks in advance.

Medical Billing and Coding Forum

Bilateral breast capsulotomy and tissue expander removal with insertion of prosthesis

Posted on by
Hi All,
Patient has a history of breast cancer and has an surgical hx of bilateral nipple sparing mastectomy.Now comes in for capsulotomy with tissue expander removal and insertion of breast prosthesis.
Please suggest CPT codes
TIA!!!

Medical Billing and Coding Forum

BREAST TISSUE REARRANGEMENT/ EXCISION SKIN LESIONs

Posted on by
Hello,
I am new to coding breast procedure. Can someone help find the code(s) to the procedure below?

The breast mass excision is 19120. Need help with other codes.

He began the left breast mass excision by excising an ellipse along what I am to be her new IMF. I used her right IMF as a template to design her new left IMF. It was significantly lower and more medial than her current left IMF which had been distorted superiorly and laterally by a large 4 x 3 cm bluish medial left inframammary fold mass. Please see his dictation for the excision portion of the procedure.
While he was working on the left side I began on the right side. With a scalpel I excised all 3 lesions previously discussed .These included a 1 cm irregular brown pigmented nevus of her right areola halfway between the nipple base and area lower margin. The length of the ellipse excised measured 2 cm to include 5 mm margin. In addition I excised a 6 mm dry crusty nonpigmented raised lesion of the sternum to the right of midline. A 2.5 cm ellipse of skin was excised to include a 5 mm margin. Finally I excised the 1 cm round raised subcutaneous lesion of the right upper chest wall with a 3 cm ellipse of skin along the midclavicular line. They were all sent to pathology for examination. Hemostasis was achieved using electrocautery. All 3 areas were injected with a total of 20 cc of quarter percent Marcaine with epinephrine for anesthesia. The lesions were irrigated with normal saline. They were closed in layers using 4-0 Polysorb in the dermis and 4-0 Biosyn the subcuticular layer.
Once Dr. completed the left breast mass excision I mobilized the left breast tissue off the pectoralis. Care was taken to maintain the superior medial and lateral blood supply to the breast tissue and nipple areolar complex. I then incised the left breast IMF to allow it to descend approximately 1.5 cm to match the contralateral side. I tacked the skin down using 2-0 Polysorb sutures to re-create the new inframammary fold. Then using 2-0 Polysorb interrupted figure-of-eight sutures I medialized the breast tissue to fill the defect left after excising the left breast mass. The patient was sat upright 90 degrees to assess the symmetry and new contour of the breast. A small amount of additional redundant skin along the new IMF was resected using the tailor tacking technique. Patient was returned to prone position. The left breast pocket was irrigated with normal saline. Hemostasis was achieved using cautery. And is 30 cc of quarter percent Marcaine with epinephrine was injected for local anesthesia. The incision was then closed in layers using 3-0 Polysorb in the dermis and 4-0 Biosyn subcuticular layer. Dermabond prineo was placed over all of the incisions. A surgical bra was placed. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.

Thanks in advance :)
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Medical Billing and Coding Forum

Get a Physician’s Perspective on Breast Health and Coding

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An interview between a surgical coder and a breast surgeon uncovers essential clinical and medical coding guidance. Breast health is an important topic for all women, and should be for men, as well. It’s especially important for Sasa-Grae Espino, MD, breast surgeon at Southside Physicians Network in Petersburg, Va. She is passionate about educating her […]
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