Wiki Coding a skin-sparing mastectomy

[LDWilliams62]

I'm currently enrolled in a CAHIIM accredited HIT program. I've taught coding for years and am now taking an ICD-10-PCS course so I can teach it. One of our coding worksheets had the case of a woman who had a bilateral skin-sparing mastectomy. I coded it as an excision, since the skin was not removed, just the tissue underneath, and was marked wrong for it.

According to the answer key our instructor provided, it was coded as a resection, which by definition means the entire breast was removed, but the answer key also has it coded with two codes, one for each side, when there is actually a bilateral code which should have been used. I'm wondering which is correct, excision or resection, and why. Thanks!

 

[mkmgt001]

CPT Assistant December 2007 states that CPT 19304 (Mastectomy, subcutaneous) is the correct code for a "skin-sparing mastectomy". Per the code description, the breast tissue is removed in this procedure, but the skin & pectoral fascia remain. A "modified" simple complete mastectomy (CPT 19303) may also spare the skin & nipple. Based on what you're stating above, I would code CPT 19304-50 for a "bilateral skin-sparing mastectomy".

Hope this is helpful!
Mary Kittredge, CPC