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#1
07-20-2012, 12:18 PM
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Partial Mastectomy- same side 2 different locations
Can someone please clarify if I can bill 19301- LT with 19301-LT, 59 for this or just 19301 LT ONCE??
OP Excerpt: Attention was turned to the left axilla, where a curvilinear incision was carried out through skin and subcutaneous tissue. Dissection was then continued down to and through the axillary investing fascia. Then the blue dye in the lymphatics was identified, followed to a total of 6 lymph nodes that were blue, as well as hot. These were separately excised after clippin the lymphatics. hemostasis was achieved with cautery. The wound was packed once this was complete. Attention was ONCE AGAIN turned to the left breast. Through the same periareolar incision which was carried out for the excision of the 4 o'clock clip, the second segmental resection was then conducted. A skin flap, measuring at least 12 cm in length, was raised to the level where wire entered the breast and beyond. The wire was brought into the skin envelope. Segmental resection was carried out by leaving the clip and wire at the center, as well as palpable abnormality at the the center. This was in continuity with the other segmental resection, once margins were excised. An additional inferior margin was excised. Therefore, there was 1 cavity that included both specimen, the first and second needle localization, in the inferolateral aspect. This dissection was carried down to include the pectoralis fascia. therefore, no posterior margin was excised. Irrigation was then used. Once this was clear and hemostasis complete, clips were placed to guide radiation therapy. Once hemostasis at both sites was complete, the subcutaneous tissue was reapproximated with 3-0 vicryl, followed by 4-0 monocryl. Steri-strips were placed, sterile dressing above that. 
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#2
07-20-2012, 01:13 PM
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Why wouldn't you use 19302 (Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy)?
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Doreen Clark, CPC, CPMA Medical Auditing Specialist Integrated Physicians Management Services East Harftord. Ct
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#3
07-20-2012, 01:42 PM
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The surgeons listing of what was performed was:
Injection for sentinel lymph node mapping Left sentinel lymph node biopsy Left breast segmental dissection, needle localization, rule out cancer, 4 o'clock periareolar. Left breast segmental resection, with excision of additional margins, 10 o'clock I coded the mapping and the biopsy which was the first paragraph excerpt.
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