CODING ADVICE REQUESTED Necrotic Breast Wound

willicoxj

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Please review the Following Dr is wanting to bill for Bilateral Mastopexies 19316-50 with Debridement codes 11042 & 11045. My gut is telling me that this is the wrong direction to go in. I could see billing for 19316-50 as mastopexies were performed but I feel like the debridement codes are inherent to and would be bundled with the mastopexy procedure as tissue is usually excisied from the breast here. OR I also considered maybe 13160? This patient did not have cancer or mastectomy. ( I am also concerned that the codes for the mastopexies will be denied as cosmetic but, that might just be a battle for another day)

THANK YOU FOR YOUR HELP!!!

PROCEDURE PERFORMED:
1. Excision of right breast scar tissue measuring 20 x 10 cm
2. Right Mastopexy
3. Left breast mastopexy for symmetry

DIAGNOSES:
1. Right breast open wound, status post necrotizing fasciitis
2. Breast asymmetry following debridement for necrotizing fasciitis

Patient recovering from bout of necrotizing fasciitis of her right breast. She was hospitalized and underwent debridement and wound VAC treatment. As a result of her debridement the patient lost her right nipple and had significant asymmetry between the sizes of her breast. Dr reshaped the right breast and removing the scar tissue and remaining area of granulation tissue. A Wise pattern incision was made similar to a breast reduction. A full thickness excision of the granulation tissue and thickened scar that over lied the lower pole of the breast was performed. Once this was done the Dr re-drapes the superior skin breast tissue flap over the remaining inferiorly based tissue in order to reshape the breast.

Once the right was completed Dr performed a traditional mastopexy for symmetry on the left breast.
 
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