Any suggestions of obtaining reimbursement for cpt 44005 when performed for 30 minutes or more with other procedure. I usually append modifier 22 but medicare doesnt want to reimburse
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Tag Archives: Mastectomy
Simple Mastectomy and removal if implants
New to Mastectomy ..
Do I have the right codes: 19303-50
or am I missing something??
PREOPERATIVE DIAGNOSIS:
Left breast carcinoma, upper outer quadrant with bilateral subglandular
implants.
POSTOPERATIVE DIAGNOSIS:
Left breast carcinoma, upper outer quadrant with bilateral subglandular
implants.
PROCEDURE:
1. Right simple mastectomy and removal of implant.
2. Left simple mastectomy with removal of implant and removal of axillary tail.
This patient had prior lymph node dissection. There was very little to no
tissue in the axilla as this had been stripped in the prior axillary node
dissection.
ASSISTANT:
xxxxxx
ANESTHESIA:
General.
ANESTHESIOLOGIST:
Dr. English.
ESTIMATED BLOOD LOSS:
Minimal.
PROCEDURE IN DETAIL:
The patient was placed on the operating table in supine position. After
administering general anesthesia, the patient’s upper chest, arms, and down to
the elbow were prepped along with the neck, prepped and draped in usual
fashion. Time-out was performed. Attention was turned to the right side,
which was benign. The oblique elliptical incision was made, sharply carried
down to subcutaneous tissue with the cautery. Then, utilizing a Gorney
scissors, skin flaps were created appropriate thickness, approximately 8-7 inch
and slightly less superiorly to the clavicle, medially to the sternum, inferiorly to the rectus, laterally to the latissimus dorsi. The breast tissue
was reflected from medial to lateral along with the implant, which was
subglandular, muscle was left intact. After this was removed, the area was
thoroughly irrigated, thorough hemostasis obtained and then a Blake drain was
placed and brought out to the inferior mammary line, sutured in position. The
skin was then closed with staples. Attention was then turned to the left
breast. Again, oblique incision was made. The patient had a prior lumpectomy
with an incision at the inferior mammary line. An oblique incision was marked.
The skin incision made and utilizing a Gorney scissors, skin flaps were
created of appropriate areas. The clavicle superiorly, latissimus dorsi and
laterally, rectus inferiorly and the sternal border medially. Then, there was
breast tissue along with the implant, was reflected from medial to lateral. It
should be noted the axillary tail was removed with the breast. There was very
little axillary tissue noted. The nerves were easily visible along with the
axillary vein. There appeared to be no lymphatic tissue present. There were
no positive palpable issues or actually very little fat in that area. Whatever
was there was removed with the axillary tail. The wound was then thoroughly
irrigated. Hemostasis obtained. A Blake drain was placed, brought out
inferiorly and sutured in position. After obtaining thorough hemostasis and
irrigation, the skin was closed with staples. Firm pressure dressings
including a breast binder were applied. Final sponge, needle, and instrument
count were correct. Sterile dressing was placed. The patient was transferred
to recovery in satisfactory condition.
Help please
Savi Scout during partial mastectomy
Hi,
If my doctor does a partial mastectomy and uses the savi probe to identify the savi reflector, would this be reported separately or considered bundled to main procedure since it is the approach? someone suggested to report unlisted 19499, but what would be the comparable code.
Thanks!!
Mastectomy coding
Hello
I recently struggle with mastectomies procedures :
The patient presents with a diagnosis of invasive ductal carcinoma of left breast. Clinical Stage I. After a complete review of treatment options, the patient has elected to proceed with breast conserving surgery.
…The left breast and axilla were prepped and draped in the usual sterile fashion.
Using gamma probe the radioactive tracer was mapped to the axilla. An incision was made at the level of the inferior left axillary hair line.
Dissection was carried down, through the clavipectoral fascia, into axilla. Guided by the gamma probe, the axilla was explored. The lymph node with radioactive counts was grasped with babcock clamp and dissected free from surrounding structures. Lymphatics and vessels were clipped. When the node was removed, exploration revealed another node with radioactive counts. This node was also grasped with Babcock clamp and dissected free from surrounding structures. Lymphatics and vessels were clipped. When both nodes had been removed there were no additional nodes remaining that were enlarged, suspicious, or containing radioactive counts above background. The sentinel nodes were sent to pathology.
Attention was turned to the breast. An elliptical incision was made in the upper ouer aspect of the left breast which incorporated the skin directly over the superficial tumor. dissection was carried out raising skin flaps and then the tumor was grasped with an Allis clamp and sharply excised. The specimen was oriented for pathology with margin mark ink.
….The breast and axillary incisions were then closed in layers…
Patient had prior sentinel node injection by radiologist 38792
my question is : do I code all the procedure this way :
38792 by radiologist
19301;38525; 38900 for surgeon ? :confused:
the most confusing is these two codes for mapping and injection : 38792&38900
Mastectomy coding
Hello
I recently struggle with mastectomies procedures :
The patient presents with a diagnosis of invasive ductal carcinoma of left breast. Clinical Stage I. After a complete review of treatment options, the patient has elected to proceed with breast conserving surgery.
…The left breast and axilla were prepped and draped in the usual sterile fashion.
Using gamma probe the radioactive tracer was mapped to the axilla. An incision was made at the level of the inferior left axillary hair line.
Dissection was carried down, through the clavipectoral fascia, into axilla. Guided by the gamma probe, the axilla was explored. The lymph node with radioactive counts was grasped with babcock clamp and dissected free from surrounding structures. Lymphatics and vessels were clipped. When the node was removed, exploration revealed another node with radioactive counts. This node was also grasped with Babcock clamp and dissected free from surrounding structures. Lymphatics and vessels were clipped. When both nodes had been removed there were no additional nodes remaining that were enlarged, suspicious, or containing radioactive counts above background. The sentinel nodes were sent to pathology.
Attention was turned to the breast. An elliptical incision was made in the upper ouer aspect of the left breast which incorporated the skin directly over the superficial tumor. dissection was carried out raising skin flaps and then the tumor was grasped with an Allis clamp and sharply excised. The specimen was oriented for pathology with margin mark ink.
….The breast and axillary incisions were then closed in layers…
Patient had prior sentinel node injection by radiologist 38792
my question is : do I code all the procedure this way :
38792 by radiologist
19301;38525; 38900 for surgeon ?
the most confusing is these two codes for mapping and injection : 38792&38900
:confused:
liposuction in gynecomastia mastectomy
Does anyone have an authoritative reference whether to code liposuction (15877) with gynecomastia mastectomy (19300)?
Coding a Partial Mastectomy with SNB and axillary lymph node dissection.
Can I code this 19302,LT, 38745,59 with 38525,59 ?????
PREOPERATIVE DIAGNOSIS: Left breast carcinoma.
POSTOPERATIVE DIAGNOSIS: Left breast carcinoma.
PROCEDURES PERFORMED:
1.Left partial mastectomy with ultrasound localization.
2.Left axillary sentinel lymph node biopsy.
3.Left completion axillary lymph node dissection.
ANESTHESIA: MAC.
ANESTHESIOLOGIST: XXXX
SURGEON: XXXX
ASSISTANT: XXX
INDICATIONS FOR PROCEDURE: 53-year-old female with a newly diagnosed left breast carcinoma. She has a clinically normal axilla. She is undergoing a partial mastectomy with axillary sentinel node sampling at this time. Risks and benefits were explained including bleeding, infection, tumor recurrence, need for additional margin resection, arm edema, nerve injury, and indications for completion axillary lymph node dissection. All questions were answered. She desires to proceed. A surgical assistant is standard, necessary, and customary for the safe performance of this procedure.
DESCRIPTION OF PROCEDURE: Monitored anesthesia care was started upon returning from lymphoscintigraphy. Intraoperative ultrasound was utilized to identify the 3 o’clock tumor. The breast and axilla were infiltrated with 1% lidocaine and 0.5% Marcaine. The axilla was initially opened. Multiple hot lymph nodes were present. The highest activity was noted to be 20,000 units on the gamma counter. Subsequent nodes measured 2000 units with background activity all being negligible less than 200 units. The identified hot lymph nodes were all dissected using electrocautery and sent for frozen sectioning. A total of five hot lymph nodes were present, two of which were grossly positive for metastatic breast carcinoma. The axilla was subsequently extended allowing for completion dissection to be performed. The axillary vein was identified and skeletonized inferiorly. The long thoracic nerve and thoracodorsal nerves were both identified and preserved. The intercostal brachial nerve was diminutive in size and difficult to separate from the surrounding fibrofatty tissue. This was intentionally divided during the dissection. The axillary contents were peeled inferiorly and sent for permanent sectioning. Upon completion, the long thoracic and thoracodorsal nerves were confirmed intact and functional. The axillary vein was noted to be hemostatic. The axilla was closed in layer over a #10 flat Jackson-Pratt drain followed by Dermabond.
The breast was incised through a 3 o’clock periareolar incision. Ultrasound was used to guide the dissection. Using electrocautery, a large core of tissue was taken enveloping the entire mass. This was excised ex vivo. Subsequent Ultrasound confirmed the mass centrally located with multiple centimeters of normal surrounding breast parenchyma with the clip easily identified centrally. Satisfactory hemostasis was assured throughout the breast cavity. Additional portions of all six margins were obtained and sent for permanent sampling. The breast had been completely skeletonized from beneath the skin leaving no additional breast tissue to be had at this location. Portions of the pectoralis major fascia were also included. Hemostasis was assured. The defect was closed in layers with absorbable suture followed by Dermabond. Multiple clips had been placed circumferentially around the cavity to allow consideration for postoperative partial breast radiation. The patient was taken to Recovery awake and uneventfully.
Mastectomy or Excision? Consider the Margins
When deciding between 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions and 19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy, search the documentation to determine whether a margin of health tissue was removed, […]
AAPC Blog
Mastectomy or Excision? Consider the Margins
When deciding between 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions and 19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy, search the documentation to determine whether a margin of health tissue was removed, […]
AAPC Blog