CULINTZ
Networker
Hello,
For the breast surgery below, can anyone provide input or guidance on the correct reporting of the closure of bilateral mastectomy defects? I have the other CPT codes for the mastectomy procedures - 19307-RT and 19303-LT.
It is described as closure of bilateral mastectomy defects rather than reconstruction. Patient is obese and not a candidate for immediate breast reconstruction.
I'm looking at CPT Codes 14301 and 14302. If I calculate the square centimeters for the defect closure, I come up with either 900 square centimeters (30 x 15) or 1500 square centimeters (30 x 25).
CPT Code 14301 covers up to 60 square centimeters of adjacent tissue transfer or rearrangement, any area; and add on code CPT Code 14302 includes each additional 30 square centimeters or part thereof.
There is an MUE of 8 for CPT Code 14302.
If I report as 900 square centimeters, I come up with 28 units of CPT Code 14302. If I report as 1500 square centimeters, this will increase the units reported to 48.
Am I looking at this correctly? I have looked at breast reconstruction codes also but this is not how this is described. Any suggestions on the correct way to report the closure? Thanks in advance!
Plastic Surgeon:
Local tissue rearrangement, closure of bilateral mastectomy defects.
1. Right modified radical mastectomy with axillary lymph node dissection.
2. Left prophylactic simple mastectomy.
The patient had been previously marked by the Plastic Surgeon and he de- epithelialized some of the tissue bilaterally in preparation for his ultimate reconstruction. I then used a skin ellipse incorporating the nipple-areolar complex. The subcutaneous tissue was entered. Skin flaps were circumferentially developed with electrocautery dissection. The limits of dissection with the clavicle superiorly, sternum medially, rectus abdominis inferiorly, and the latissimus dorsi muscle laterally. The breast was removed from the chest wall incorporating pectoralis fascia. We used the LigaSure for the medial dissection in the axilla. The axillary contents were left attached to the tail of the breast. The dissection 1st was carried out superiorly where the axillary vein at its inferior border was clearly identified and this was the most superior margin of dissection. The level 1 and 2 nodes were swept downward again using the LigaSure for hemostasis. Medially, the thoracodorsal trunk was identified and the long thoracic nerve identified and spared from injury. Laterally when we encountered any vessels or lymphatics, small hemoclips were used on them. At 1 point, we cut across 2 small lymphatics that had blue dye, but otherwise so no blue dye stained lymphatics. The axillary contents were swept down and left attached to the tail of the breast. There were some clearly involved lymph nodes. The breast was removed. It was painted with the ink according to the directive of the Pathology Department. This wound was irrigated and hemostasis was complete. A wet towel was placed over the wound and we now approached the opposite side. Again, the Plastic Surgeon had de- epithelialized portion of the breast skin centrally. I made a skin ellipse, then and incorporating the central skin of the breast as well as the nipple-areolar complex identical to that on the opposite side. The subcutaneous tissue was entered. Hemostasis throughout was achieved with electrocautery and 4-0 Vicryl ties. Skin flaps were then circumferentially developed with electrocautery dissection, the limits of dissection with the clavicle superiorly, sternum medially, rectus abdominis inferiorly, and the latissimus dorsi muscle laterally. The breast was then removed from the chest wall incorporating the pectoralis fascia. It was removed with side table and painted with ink according to the directive of the Pathology Department and the breasts were weighed. The right breast tissue weighed 972 g. The left weighed 1090 g. This wound was irrigated. Hemostasis was complete. Again, this wound was covered as the Plastic Surgeon would be closing those incisions and he would be placing the drains.
For the breast surgery below, can anyone provide input or guidance on the correct reporting of the closure of bilateral mastectomy defects? I have the other CPT codes for the mastectomy procedures - 19307-RT and 19303-LT.
It is described as closure of bilateral mastectomy defects rather than reconstruction. Patient is obese and not a candidate for immediate breast reconstruction.
I'm looking at CPT Codes 14301 and 14302. If I calculate the square centimeters for the defect closure, I come up with either 900 square centimeters (30 x 15) or 1500 square centimeters (30 x 25).
CPT Code 14301 covers up to 60 square centimeters of adjacent tissue transfer or rearrangement, any area; and add on code CPT Code 14302 includes each additional 30 square centimeters or part thereof.
There is an MUE of 8 for CPT Code 14302.
If I report as 900 square centimeters, I come up with 28 units of CPT Code 14302. If I report as 1500 square centimeters, this will increase the units reported to 48.
Am I looking at this correctly? I have looked at breast reconstruction codes also but this is not how this is described. Any suggestions on the correct way to report the closure? Thanks in advance!
Plastic Surgeon:
Local tissue rearrangement, closure of bilateral mastectomy defects.
- Patient has a newly diagnosed right breast cancer and a history of left breast cancer, treated with lumpectomy without radiation. Of note, she exhibits obesity and is not a candidate for immediate breast reconstruction at this time. She is undergoing right breast modified radical mastectomy and left breast completion mastectomy under the direction of the Breast Surgeon. This will be dictated in detail by him.
- Attention was focused on closure of the breast. Of note, each of the inferior de-epithelialized mastectomy flaps were backcut and advanced superiorly along the breast meridian. These measured 30 cm x 15 cm. The suture mastectomy flap was infolded and the breast was tailor tacked after placing two 19-French Blake drains within each mastectomy defect. The same set of tissue rearrangement maneuvers were performed and closure was performed with 3-0 Monocryl deep dermal suture and 4-0 Monocryl running subcuticular suture. Total local tissue rearrangement area was 30 x 25 cm at each mastectomy site.
1. Right modified radical mastectomy with axillary lymph node dissection.
2. Left prophylactic simple mastectomy.
The patient had been previously marked by the Plastic Surgeon and he de- epithelialized some of the tissue bilaterally in preparation for his ultimate reconstruction. I then used a skin ellipse incorporating the nipple-areolar complex. The subcutaneous tissue was entered. Skin flaps were circumferentially developed with electrocautery dissection. The limits of dissection with the clavicle superiorly, sternum medially, rectus abdominis inferiorly, and the latissimus dorsi muscle laterally. The breast was removed from the chest wall incorporating pectoralis fascia. We used the LigaSure for the medial dissection in the axilla. The axillary contents were left attached to the tail of the breast. The dissection 1st was carried out superiorly where the axillary vein at its inferior border was clearly identified and this was the most superior margin of dissection. The level 1 and 2 nodes were swept downward again using the LigaSure for hemostasis. Medially, the thoracodorsal trunk was identified and the long thoracic nerve identified and spared from injury. Laterally when we encountered any vessels or lymphatics, small hemoclips were used on them. At 1 point, we cut across 2 small lymphatics that had blue dye, but otherwise so no blue dye stained lymphatics. The axillary contents were swept down and left attached to the tail of the breast. There were some clearly involved lymph nodes. The breast was removed. It was painted with the ink according to the directive of the Pathology Department. This wound was irrigated and hemostasis was complete. A wet towel was placed over the wound and we now approached the opposite side. Again, the Plastic Surgeon had de- epithelialized portion of the breast skin centrally. I made a skin ellipse, then and incorporating the central skin of the breast as well as the nipple-areolar complex identical to that on the opposite side. The subcutaneous tissue was entered. Hemostasis throughout was achieved with electrocautery and 4-0 Vicryl ties. Skin flaps were then circumferentially developed with electrocautery dissection, the limits of dissection with the clavicle superiorly, sternum medially, rectus abdominis inferiorly, and the latissimus dorsi muscle laterally. The breast was then removed from the chest wall incorporating the pectoralis fascia. It was removed with side table and painted with ink according to the directive of the Pathology Department and the breasts were weighed. The right breast tissue weighed 972 g. The left weighed 1090 g. This wound was irrigated. Hemostasis was complete. Again, this wound was covered as the Plastic Surgeon would be closing those incisions and he would be placing the drains.