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#1
07-18-2012, 01:38 PM
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Simple Mastectomy with Sintenel Node Biopsy
Can someone please give me some insight as to how to code this procedure.
DESCRIPTION OF OPERATION Technetium was injected. The patient was brought to the operating room table and placed in the supine position. General anesthetic was induced. At this point, I did inject some Lymphazurin blue 1.5 mL just underneath the nipple areolar complex. The breast, chest wall, axilla and upper arm were adequately prepped and draped in the usual sterile fashion. With the preoperatively nuclear medicine located mass, it was contained without the proposed mastectomy incision so an incision was made at this point and carried down through the subcutaneous tissues and, using the gamma counter probe, a high signal was obtained and very blue area was observed. This was resected in its entirety and, extracorporally, it was again identified to be hot on the gamma probe and dark blue. This was sent for frozen specimen which came back negative for any malignancy. So, a skin incision was made that encompassed the nipple areolar complex in a generally transverse incision. Parts were raised in the avascular plain between subcutaneous tissue and breast tissue from the clavicle superiorly, sternomedially, the anterior rectus sheath, inferiorly, and past the lateral border of the pectoralis major muscle laterally. Hemostasis was achieved with the harmonic scalpel. Next, the breast tissue and the underlying pectoralis fascia were excised from the pectoralis major, progressing from medially to laterally. At the lateral border of the pectoralis major muscle, the breast tissue was swung laterally in the lateral pedicle, identified where breast tissue gave way to fat of the axilla. The lateral pedicle was incised and the specimen removed. The wound was then irrigated. Hemostasis was achieved. Closed suction JP drain was then brought into the operative field through a separate stab-wound incision and sutured with a #3-0 nylon suture. The wound was closed with #3-0 Vicryl for the subcutaneous layer and #4-0 Monocryl for the skin. The wound was then injected with 0.5% Marcaine with epinephrine. Provena Wound VAC system was placed and a pressure dressing was applied. The patient tolerated the procedure well and was moved to the PACU in stable condition. Anesthesia for this case was general. 
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#3
07-18-2012, 03:15 PM
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19303 is a simple mastectomy, and does cover the description above. Sentinel Axillary Lymph Node Biopsy is 38525. There is a CPT Assist article that directs you to use the deep node codes for sentinal node biopsies. Need to know if it's LT or RT, and add that modifier to both codes. NCCI allows them to both be billed together, as well. Depending on your facility/billing expectations, there is a code for the dye as well, that can be reported separately: 38900. Thanks!
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