General Surgery Coding Alert

Question: If the surgeon excises a breast mass from the lower inner quadrant based on a prior biopsy cancer diagnosis, and also removes two axillary lymph nodes through a separate excision, should we bill 19301 plus 38740?

Michigan Subscriber

Answer: No, you should not report the service as 19301 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy)] plus 38740 (Axillary lymphadenectomy; superficial).

Do this: Instead, you should bill the service using the single most specific code -- 19302 (...with axillary lymphadenectomy).

Although 38740 versus 38745 (... complete) allows you to indicate that the lymphadenectomy your surgeon performed was superficial rather than total, that's not the proper choice when the partial mastectomy occurs during the same surgical session.

Code 19302 is appropriate when the surgeon performs a lumpectomy and axillary lymphadenectomy during the same surgical session, whether superficial or complete, and whether contiguous or through a separate incision.