Breast Mastectomy

[BABS37]

I'm stuck on a mastectomy and not sure what all I should bill for. Here's the OP note:

...The left chest and axilla were prepped. 2cc of methylene blue dye were injected in the retroareolar dermis and the breast was massaged. An elliptical incision was marked and incised. Flaps were elevated superiorly to the infraclavicular border medially to the edg eof the sernum and inferiorly to the inframammary creast laterally to the surface of the axilla. From this point the axilla was entered. Neoprobe was used to guide dissection efforts and sentinel node, which was firm to palpation and without blue dye staining, was harvested and sent to path. This was returned on the frozen section as invasive cancer and therefore plans were made for an axillary dissection in light of those result. The breast was elevated now from the surface of the pectoral muscle, taking the pectoral fascia as well. The breast was separated from the attachments to the axillary fossa, marked with a short stitch superiorly and a long stitch laterally and submitted to path. Axially dissection was begun following the pectoral muscle up to identify the axially vein. The axially contents were cleared off from the chest wall, identify and preserving the long thoracic nerve. The axillary contents were swept inferiorly from the axillary vein leaving the nodal tissue superior to the axillary vein in place. The thoracodorsal nerve, artery and vein were identified and preserved as the remainder of the axillary contents were swept inferiorly off the subscapularis and latissimus. The remaining attachments were divided...

Do I use 19302 or 19303 with 38792, 38525? Or does the biopsy not get coded since he did the full procedure? Thoughts? Codes?

[cwpierce]

Code as 19302.

38792 became global as soon as they did the mastectomy because the biopsy is part of the larger procedure when done during the same procedure.

19303 is for the mastectomy only and 38525 is for some but not all of the lymph nodes only.

Think of it this way.... 38525 is used when say, 1 - 5 nodes are excised but in this report it appears that all of the axillary lymph nodes were excised so we wouldn't use it here.

Let's not forget to add 38900 for th lymphatic mapping and as such I would code this as follows:

1. 19302 - Matectomy w/ complete lymphanectomy
2. 38900 - Lymphatic Mapping

Hope this was helpful.

[vaishali]

Originally Posted by cwpierce

Code as 19302.

38792 became global as soon as they did the mastectomy because the biopsy is part of the larger procedure when done during the same procedure.

19303 is for the mastectomy only and 38525 is for some but not all of the lymph nodes only.

Think of it this way.... 38525 is used when say, 1 - 5 nodes are excised but in this report it appears that all of the axillary lymph nodes were excised so we wouldn't use it here.

Let's not forget to add 38900 for th lymphatic mapping and as such I would code this as follows:

1. 19302 - Matectomy w/ complete lymphanectomy
2. 38900 - Lymphatic Mapping

Hope this was helpful.

After reading this I still have one doubt, shouldn't we code 38525 also with mod 59 as dissection was only planned after the path results came out positive.
Please help.

[BABS37]

Thank you both! So does anyone have a cheat sheet to make mastectomy coding more understandable by chance? I guess I get confused what exactly is happening. I get really confused on which one to use between 38500 and 38525 and also on 38792 vs 38900.

[cgoodling]

If you get a cheat sheet, could I please get a copy? I have a difficult time with mastectomy coding, as well. Thanks!