Two Friends Inspire Others with Their Courage
They share their journeys of breast cancer diagnoses.
By Freda Brinson, CPC, CPC-H, CEMC,
I’d like to share with you the real experiences of two women diagnosed with various types and stages of cancer. I hope you find their true stories insightful and inspiring.
Thirty-three-year-old Susan—wife, mother, sister, daughter, friend, and full-time apartment manager—noticed changes in her breast. There was a knot under her arm, and her left breast was more swollen than the right. She assumed that the changes were due to breastfeeding her 8-month-old son, and her doctor agreed.
Susan’s symptoms continued after she was no longer breastfeeding. She shared her concerns with Lisa, a 32-year-old coworker who noticed changes in her own breast, as well. Both women decided to do some quick online research.
Susan didn’t like what she found. She also knew her father’s side of the family had a history of breast and ovarian cancers. She decided to go for a mammogram. Because of information she had found during her research, Susan wasn’t that surprised when the diagnosis was finally delivered. Her exact symptoms were listed online, and they pointed to one thing: inflammatory breast cancer (IBC).
IBC is an aggressive cancer that occurs in approximately 1 percent of people with invasive breast cancer. The cancer occurs in the cells of the breast, but does not form an actual tumor—Susan described it as “a chicken soup of cancer.”
“So many things run through your head when you get a cancerdiagnosis,” Susan said. Her first thought was, “I am going to die. I was so scared! I wanted to see my children grow up. My baby was only 8 months old.
“I still have those thoughts from time to time,” Susan said, “especially when I’ve had so many relatives die from cancer. And I hear the stories of people ‘beating’ it, only to have it come back later and find out it isn’t treatable. I will always have that fear, but I have to kick those thoughts and feelings out of my head because I truly believe that a positive attitude and outlook is key in getting through this.”
When IBC is diagnosed, it’s at least stage IIIB. Susan was diagnosed initially as stage IV, but this was later revised to stage IIIC, triple-negative (non-hormone receptive, which is harder to treat). The revision was due to a computed tomography (CT) scan showing lesions on her lung and liver; positron emission tomography (PET) confirmed the spots were too small to biopsy. Between the CT and PET results, fervent prayers were being lifted on Susan’s behalf: She was, and continues to be, on many prayer lists.
Diagnosis: Stage IIIC inflammatory cancer of the left midline breast, primary.
ICD-9-CM code: 174.8 Malignant neoplasm of other specified sites of female breast
Susan knew she had to tell her 8-year-old son, Jackson, the news, but she struggled with what say and how to say it. She and her husband, Chris, decided to tell their son before she started chemotherapy. They explained that she had cancer, but tried to minimize its seriousness.
“We told Jackson that I would have a bunch of doctor appointments, and I would lose my hair and have surgery to remove my breasts, but within a year I would be back to normal,” Susan said. The talk went well, but with a child’s innocence, Jackson asked if she would be a boy, since she would be bald and boob-less.
Ten days after her diagnosis, Susan began her first of eight rounds of chemotherapy. At the same time, she had additional testing, including another CT scan, a bone scan, an echocardiogram, a port insertion, and genetic testing. She also met with her oncologist and radiation oncologist.
A cocktail of powerful chemotherapy drugs—Adriamycin® (aka “the red devil”), Cytoxan®, Neulasta®, and Taxol®—were used to shrink tumors. The mix was administered every other week as an intravenous infusion, via an implanted port. The infusion lasted approximately three hours, during which time Susan was with other patients receiving their own rounds of chemotherapy.
Infusions: 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug with 2 units of +96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure).
Push: +96411 Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)
Injection: 96372 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
Note: Some payers consider Neulasta® to be a chemotherapy agent in some circumstances. Check with your payer prior to reporting CPT® code 96401 Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic.
Just after the second chemotherapy treatment, Susan’s hair began to fall out—not all at once, but in clumps, here and there.
“This was VERY TRAUMATIC!” she emphasized. “I had so much hair. It was falling out everywhere.” Susan made the decision to shave her head, and did so at home with the help of her husband and son. (As someone who has seen the clean-shaved Susan, I can tell you she is beautiful. Her face is perfect and her eyes are full of life.)
As each treatment was completed, the side effects became more severe. For days following chemo, Susan had strong, flu-like symptoms, including body aches, joint pain, weakness, nausea, and malaise. As she described it, “I was more car sick than anything else. It really felt like I had the flu, strep throat, and a sinus infection—all at once. I was extremely tired and nauseous. But I only threw up one time.
“The Taxol gave me horrible bone pain,” Susan continued. “It’s hard to describe, but I felt like I had huge weights being thrown on me. It was hard to walk or put weight on my legs, which was where most of the pain was.” She also experienced extreme dry mouth, heartburn, and tingling and numbness in her fingers and toes. Food didn’t taste the same, Susan said, but she didn’t have the “metal taste” that others sometimes describe. Her symptoms were treated as best as possible.
Witnessing the side effects was hard on Chris. He tried not to show his worry in front of Susan, as he knew that would cause her to worry about him. Chris was able to talk and vent his fears to his mom.
Mastectomy and More
As Susan and her family prepared for the Christmas holidays, she was also planning her next course of treatment. This included a double mastectomy.
Procedural coding: 19306-50 Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes-Bilateral procedure
Susan has the gene BRCA1, which research has shown increases the likelihood that breast cancer will metastasize to ovarian cancer by 60 percent. A future hysterectomy is planned. Unfortunately, Susan’s sister is also positive for the BRCA1 gene, and a candidate for the same procedures as Susan. Her sister’s surgery will be scheduled following the delivery of her second child.
Following the mastectomy and a short recovery (as soon as she is able to extend her arms over her head), Susan will start her course of radiation therapy, which will consist of 33 days of 20-minute sessions. After that, the plan is for Susan to return to her life—without cancer. Susan is confident: “I know I will beat this stupid cancer!”
Following her diagnosis, Susan urged her friend and coworker, Lisa, (who had also experienced breast changes) to see a doctor. It was a smart decision.
Early Detection Matters
Following a percutaneous biopsy and lesion excision, a diagnosis of complex sclerosing lesion (aka, radical scar or fibroadenosis of the breast) was confirmed. This type of lesion commonly hides behind or around cancer cells, and may be considered premalignant.
CPT®: 19083 Biopsy, breast, with placement of breast localization device when performed, and imaging of the biopsy specimen when performed, percutaneous; first lesion including ultrasounds guidance
ICD-9-CM: 611.72 Lump or mass in breast
Lisa’s pathology returned as sclerosing adenosis with no malignant cells. Her course of treatment is over, unless she chooses to have reconstructive surgery to correct the slight difference in breast size.
CPT®: 19285 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance
19125 Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion
Modifier 59 Separate procedure and/or modifier 51 Multiple procedures may be required when reporting these codes for the same operative session, depending on the payer.
ICD-9-CM: 610.2 Fibroadenosis of breast
Breast Cancer Is Every Woman’s Concern
In case it isn’t obvious, Lisa and Susan are very special to me. Lisa is my daughter, and Susan is her best friend. Both women were willing to share their very personal experiences with us because they are committed to:
- Getting and staying healthy
- Doing what they can to instill in all women, but especially women under the age of 40 (the typical age of your first mammogram), that they need to trust when they discover something different in their bodies, and to push (hard, if necessary) to get the proper testing done.
Don’t let their experiences be in vain. Talk to your family and friends (and yourself) about taking care of even the slightest breast changes. Early detection is still the key. Age does not matter: Women under age 40 can and do get breast cancer. Cancer is not always a lump. You must pay attention to any change.
Both women will also tell you their journeys have not been all bad—both have learned some very important life lessons. Susan admits she has had several “come to Jesus” moments, and Lisa has learned to slow down and take time for herself and her family—not always easy in our fast-paced world.
Freda Brinson, CPC, CPC-H, CEMC, compliance auditor for St. Joseph’s/Candler Health System in Savannah, Ga., has worked in healthcare for over 30 years. A member of AAPC since 1996, she is president of the newly created Swainsboro, Ga., local chapter. Previously, Brinson was a member of the Savannah local chapter, serving in various officer positions. She was also an AAPC Chapter Association board member from 2009-2012.
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