19125,19126,or 19301

codedog

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confused on this,doc office says use 19301x2 with 38525, while I think it may be 19125,19126,38525,
if I am wrong, is it because of the margins ?


PREOPERATIVE DIAGNOSIS: Right breast mass.
POSTOPERATIVE DIAGNOSIS: Right breast mass.
OPERATIONS: 1. Excision of needle localized breast mass. 2. Sentinel lymph node biopsy, all of this on the right side.
COMPLICATIONS: None.
ANESTHESIA: General.
BLOOD LOSS: Less than 10 cc.
PROCEDURE:
The patient was taken to the OR, prepped and draped in the usual sterile fashion. Prior to this, we had two needles placed by ultrasound guidance in the suspicious area. These were at the 9 and 10 o'clock position. Once the patient was prepped, she was injected with 1 cc of Lymphazurin and the Neoprobe was used to localize an area in the right axilla. 5 cc of 0.25% Marcaine-lidocaine were infiltrated over the area. This was incised and carried down with electrocautery. Once the axilla was entered, a blue node was found which was both hot and blue. This was excised and sent for pathology. Pathology came back as a negative sentinel lymph node. A curvilinear incision was made in between the two needles which were located in the right upper quadrant. This was infiltrated with 5 cc of 0.25% Marcaine, 1% lidocaine, and incised with a scalpel. Incision was carried down with electrocautery and small flaps were raised. We were able to encircle both ends of the tips of the needle with a good margin around it. This was all excised using the Harmonic scalpel. Once this was taken out, one more small area in the deep area of the wound was excised. There was excellent hemostasis. The deep tissue was closed with 3-0 Vicryl and the skin was closed with 4-0 Vicryl. All needle, sponge, and instrument counts were correct.
 

awest

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I agree with what the doc office wants to bill. I don't see where they were identified preoperatively, and the 19125 states: Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion.

Just my thoughts...
 
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