Hi
Here is the operative report.
After some careful consideration inlcuding the mammographic images that were used as a reference and with palpation of the breast I elected to approach both of the lesions through a more generous single incision rather than 2 separately placed incisions. The reason that this could be performed was because the lesions were roughly within the same horizontal plane, they were simply in different vertical planes. I therefore raised a transverse skin wheal just below or at the level of the lower portion of the areola and lateral to the areola. I made a skin incision. This incision bisected the first wire that was placed that was marking the more medial anterior lesion. I created rather thick flaps and followed this wire down to the tip and then excised a portion of breast tissue that was just off the tip that contained a very distal aspect of the hookwire.Within this specimen I had the sense that there was a palpable lesion and this was submitted in formalin as the anterior lesion. Following this I sharply incised the lateral portion of the breast creating a thick superior flap until I encountered the wire that had been placed throughthe superior-most portion of the breast. The entry site of the wire was quite removed from lesion itself and I cut the wire just above the skin surface and withdrew it into the surgical wound. I then sharply excised a portion of the breast tissue that contained the distal aspect of the wire and the superficial specimen was excised to the pectoralis muscle making sure that I captured all of the breast tissue anterior to the pectoralis. This lesion was submitted for mammography and the specimen was documented to contain the lesion Hemostasis was then obtaine with cautery.
My question is because we did not put two separate wires do I code
19125 for the first lesion (as that code states single lesion) and then 19120?
I don't feel that I can code 19126 as that state each additional lesion separately identified by a preoperative radiological maker.
This was 1 needle localization but he did excised 2 separate breast lesions, same breast but different areas.
Any guidance would be helpful.
Thank you
Marci
Here is the operative report.
After some careful consideration inlcuding the mammographic images that were used as a reference and with palpation of the breast I elected to approach both of the lesions through a more generous single incision rather than 2 separately placed incisions. The reason that this could be performed was because the lesions were roughly within the same horizontal plane, they were simply in different vertical planes. I therefore raised a transverse skin wheal just below or at the level of the lower portion of the areola and lateral to the areola. I made a skin incision. This incision bisected the first wire that was placed that was marking the more medial anterior lesion. I created rather thick flaps and followed this wire down to the tip and then excised a portion of breast tissue that was just off the tip that contained a very distal aspect of the hookwire.Within this specimen I had the sense that there was a palpable lesion and this was submitted in formalin as the anterior lesion. Following this I sharply incised the lateral portion of the breast creating a thick superior flap until I encountered the wire that had been placed throughthe superior-most portion of the breast. The entry site of the wire was quite removed from lesion itself and I cut the wire just above the skin surface and withdrew it into the surgical wound. I then sharply excised a portion of the breast tissue that contained the distal aspect of the wire and the superficial specimen was excised to the pectoralis muscle making sure that I captured all of the breast tissue anterior to the pectoralis. This lesion was submitted for mammography and the specimen was documented to contain the lesion Hemostasis was then obtaine with cautery.
My question is because we did not put two separate wires do I code
19125 for the first lesion (as that code states single lesion) and then 19120?
I don't feel that I can code 19126 as that state each additional lesion separately identified by a preoperative radiological maker.
This was 1 needle localization but he did excised 2 separate breast lesions, same breast but different areas.
Any guidance would be helpful.
Thank you
Marci