19125 or 19301

codedog

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There are times when I read an operative report and I read it twice and then start second guessing myself, not sure about this one . I first look at this and want to code this as 19301 as a lumpectomy , but then look at it again and want code this as 19125- needle loc. Which one is right, 19125or 19301 ?

PREOPERATIVE DIAGNOSIS: DCIS, 2-3 mm focus, stereotactic biopsy.

POSTOPERATIVE DIAGNOSIS: DCIS, 2-3 mm focus, stereotactic biopsy.

PROCEDURE PERFORMED: Needle localization lumpectomy.

ASSISTANT: None.

ESTIMATED BLOOD LOSS: Minimal.

COUNTS: Lap sponge, and needle counts were all correct.

PROCEDURE IN DETAIL: After appropriate informed consent was signed, the patient was taken to the operating room, was transferred to the operating table and underwent general anesthesia with successful endotracheal intubation. Prior to making a skin incision, the right breast was prepped and draped in normal fashion. The area of interest appeared to be at the end of the wire with the previous biopsy clip and also with some calcification located there, dissected again through skin and subcutaneous tissue using a wire. The wire and surrounding area of the wire with about 4 to 5 cm tissue removed to make sure had everything. We sent to radiology to confirm _____ specimen was out of the patient, that the clips and noted calcification were in the specimen. Excellent hemostasis was noted to be obtained. The wound was closed with 3-0 nylon in interrupted fashion. Sterile dressing was placed. The patient tolerated the procedure and was transported to the recovery room in stable condition.:confused:
 

nsteinhauser

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I would code a 19125 - RT. I've noticed some surgeons call all breast tissue excisions 'lumpectomies' and it gets confusing.
 

codedog

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just received path report and path reportv it stated the margins were free of tumor, so doctor did pay attention to the margins, so would 19301 be the one to choose if magins were clear ?
 

nsteinhauser

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Trent, I understand what you're saying.....the lay description for the 19125 says the "lesion and marker are excised, without attention to obtaining clean margins. " and the lay description for the 19301 says "excises a breast tumor and a margin of normal tissue by performing a partial mastectomy by making an incision through the skin and fascia over a breast malignancy and clamping any lymphatic and blood vessels. The physician excises the mass along with a margin or rim of healthy tissue." And CPT Assistant from February 2007 says "Code 19301, Mastectomy, partial: Partial mastectomy procedures describe open excisions of breast tissue and include specific attention to adequate surgical margins surrounding the breast mass or lesion. In a partial mastectomy, a larger amount of breast tissue and some skin are removed with the tumor. This also includes removal of the lining over chest muscles below the tumor. This surgery is usually performed for stage 1 and 2 tumors. This code is reported also for the performance of a lumpectomy where the tumor and a small amount of surrounding tissue are removed."

SO maybe 19301 is the correct choice. My gut still says '19125' ... maybe because the 19301 seems to be more involved. We need a breast expert to weigh in on this!
 

codedog

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thanks Nancy , will hold on to this one, I know a doctor can sometimes leave info out:confused:
 
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jmcpolin

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I too am in question with these 2 codes we have a patient that had a prior mastectomy 5 years ago by a different surgeon, recurrent breast cancer now and our surgeon wen in and removed part of the chest wall but no muscle or bone. There are markers in place, I say 19125 and the surgeon wants to bill 19301.
 
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