Could use some help on general Surgery note 3

Sage123

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POSTOPERATIVE DIAGNOSIS: DCIS of the left breast
PROCEDURES PERFORMED: Isotope injection, this was all in the left breast, stereotactic wire localization, sentinel node biopsy, left lumpectomy, and insertion of Foley catheter.

I'm missing something. I coded the DX and stereotactic wire localization, sentinel node biopsy, left lumpectomy, but will not except Foley catheter code for the breast. Has anyone done this? Just please throw me a bone.
 
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pkidd

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Breast surgery

Hello,

Agree with Courtney - you can only charge (code) the stereotactic wire implant & injection of the "blue dye" if your surgeon performed this part of the procedure. In our practice, the mammographic radiologist inserts the catheter and injects the dye. During the course of the procedure while searching for the lymph node/s, my surgeon may inject a bit more dye. When this occurs, I charge (code) the injection only.

Foleys: Most often insertion of foleys or drainage tubes is considered part of the procedure and therefore, not billable.

Hope this is helpful,
Pat Kidd
pkidd@samhealth.org
 

Sage123

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Thank you ladies. I'm still missing something but unsure what now. With your help I found 2 more CPT codes thank.
 

jennileeo

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Hi,
Did you ever get the answer? I need one or two codes too. I've already codes the following:
233.0
38525
38792
19290
I can't figure out what I'm missing... Please help
 
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19291 you are still missing adding the extra wires but i am afraid i am still missing a code on top of all the ones you have and this one :(
 

ckipiani

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op note #3

I'm stuck on same case #3: So far, I have these codes...

233.0
19290 51 lt
19291 lt
19125 lt
38792 lt
38525 lt

I'm thinking there is only one more code to this case. Help!! Thx.....
 

BEARDOG

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Without the full op note it is hard to determine what was done, however, all of my surgeons when doing a sentinel node biopsy use two methods of mapping. If this is the case with your procedure you may want to consider 38900 which is intraoperative lymphatic mapping with dye if this procedure was done. Read your op note and if they say they injected the dye and found the blue nodes this is a billable code. Usually the nuclear med doc's will do the lymphoscintigraphy and the surgeons do the blue dye injection and intraoperative mapping.

Hope this is helpful...
 

jskalet

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Op note #3

I have all the same codes as everyone else. I did try to enter 38900 but am being told that is an incorrect code. I am totally stumped on this one! If anyone has any other suggestions on what we are missing, please help!!
 

Sage123

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I remember this one very well. It took me forever but I was to stupid not to note this one down. I did notice you don't have 19301. See if that helps. Please let me know on here if it does.
 

jskalet

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Op note #3

I tried entering 19301 and am being told it is an incorrect code. Here is the whole op note for those that are trying to help us find the last code. I appreciate everyone's efforts :)

OPERATIVE REPORT
DATE OF PROCEDURE: 05/14/20xx
PREOPERATIVE DIAGNOSIS: DCIS of the left breast
POSTOPERATIVE DIAGNOSIS: DCIS of the left breast
PROCEDURES PERFORMED: Isotope injection, this was all in the left breast, stereotactic wire localization, sentinel node biopsy, left lumpectomy, and insertion of Foley catheter.
ANESTHESIA: Local and general.
INDICATIONS OF THE PROCEDURE: This is a 62-year-old patient of admitted to the hospital for treatment of her left breast carcinoma. This was documented in my admission history and physical.
DESCRIPTION OF THE PROCEDURE: The patient first of all was injected with 500 microcuries of technetium sulfa-colloid intradermally and circumareolarly. The patient was then taken to the stereotactic room where in the lateral orientation after placing the patient in the prone position with left breast going to be opening on the table the area of the prior biopsy was identified. Using a triangulation technique, three Hawkins wires were delivered into the breast at 12 o'clock, 4 o'clock, and 8 o'clock position. She was then taken to the OR where the breast was prepped and draped in the routine fashion. The lesion was very superficial and then in order to be able to obtain an adequate margin closed to the skin I had to remove an ellipse of skin including all three wires in that ellipse. Dye was injected into the patients axilla area to aid locating any sentinel lymph nodes. First thing that we did though was excise the sentinel nodes, making an incision over the point of maximum activity in the axilla, taking the dissection down to the most superficial axilla identifying a hot and blue lymph node. This was excised using Hemoclips and Bovie. The activity of the lymph node was 3300. Using the gamma probe, no further activity was noted in the axilla with the gamma probe. This was closed in two layers with #3-0 Vicryl and #4-0 Vicryl subcuticular sutures. The ellipse of skin was then removed using a curvilinear incision cutting all three wires in the ellipse of skin that was removed. Dissection was taken in depth all the way down to the breast tissue proper removing all of the skin and the breast tissue that was encompassed by the wires. A deep margin was marked with one suture and the inferior margin was marked with two. I performed a radiological examination of the surgical specimen which revealed that the couple of margins might have been little bit close, and the inferior one and both separate margins were then sent for separate pathological examination. Next, through a separate stab incision in the lateral aspect of the breast, a #22 Foley was inserted into the cavity and the balloon was inflated to 30 cc and then, the breast was closed over this creating an adequate cavity in layers using #2-0 and # 3-0 Vicryl interrupted sutures. The skin was closed with subcuticular closure of # 4-0 Vicryl and then I went ahead and checked our cavity using ultrasound. There was good uniform cavity and we had at least 1.5 cc of margin throughout. Being satisfied with this, the Foley was deflated to 15 cc only. Dressing was applied. Also, we noted that the signs and symptoms were negative for carcinoma.
 

rollinholy

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I tried entering 19301 and am being told it is an incorrect code. Here is the whole op note for those that are trying to help us find the last code. I appreciate everyone's efforts :)

OPERATIVE REPORT
DATE OF PROCEDURE: 05/14/20xx
PREOPERATIVE DIAGNOSIS: DCIS of the left breast
POSTOPERATIVE DIAGNOSIS: DCIS of the left breast
PROCEDURES PERFORMED: Isotope injection, this was all in the left breast, stereotactic wire localization, sentinel node biopsy, left lumpectomy, and insertion of Foley catheter.
ANESTHESIA: Local and general.
INDICATIONS OF THE PROCEDURE: This is a 62-year-old patient of admitted to the hospital for treatment of her left breast carcinoma. This was documented in my admission history and physical.
DESCRIPTION OF THE PROCEDURE: The patient first of all was injected with 500 microcuries of technetium sulfa-colloid intradermally and circumareolarly. The patient was then taken to the stereotactic room where in the lateral orientation after placing the patient in the prone position with left breast going to be opening on the table the area of the prior biopsy was identified. Using a triangulation technique, three Hawkins wires were delivered into the breast at 12 o'clock, 4 o'clock, and 8 o'clock position. She was then taken to the OR where the breast was prepped and draped in the routine fashion. The lesion was very superficial and then in order to be able to obtain an adequate margin closed to the skin I had to remove an ellipse of skin including all three wires in that ellipse. Dye was injected into the patients axilla area to aid locating any sentinel lymph nodes. First thing that we did though was excise the sentinel nodes, making an incision over the point of maximum activity in the axilla, taking the dissection down to the most superficial axilla identifying a hot and blue lymph node. This was excised using Hemoclips and Bovie. The activity of the lymph node was 3300. Using the gamma probe, no further activity was noted in the axilla with the gamma probe. This was closed in two layers with #3-0 Vicryl and #4-0 Vicryl subcuticular sutures. The ellipse of skin was then removed using a curvilinear incision cutting all three wires in the ellipse of skin that was removed. Dissection was taken in depth all the way down to the breast tissue proper removing all of the skin and the breast tissue that was encompassed by the wires. A deep margin was marked with one suture and the inferior margin was marked with two. I performed a radiological examination of the surgical specimen which revealed that the couple of margins might have been little bit close, and the inferior one and both separate margins were then sent for separate pathological examination. Next, through a separate stab incision in the lateral aspect of the breast, a #22 Foley was inserted into the cavity and the balloon was inflated to 30 cc and then, the breast was closed over this creating an adequate cavity in layers using #2-0 and # 3-0 Vicryl interrupted sutures. The skin was closed with subcuticular closure of # 4-0 Vicryl and then I went ahead and checked our cavity using ultrasound. There was good uniform cavity and we had at least 1.5 cc of margin throughout. Being satisfied with this, the Foley was deflated to 15 cc only. Dressing was applied. Also, we noted that the signs and symptoms were negative for carcinoma.
I agree with you and Beardog; this is how I would code it but open for suggestions
19301, 38525-59, +38900, 233.0
 

Sage123

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Oh I was off just by a little bit.:rolleyes: Thanks for the OP note. I was hoping to NEVER see this one again but here I go.

DX:
DCIS of the left breast: 233.0

CPT CODES:

stereotactic wire localization left breast---19290 LT, 19291 LT
sentinel node biopsy left breast, 19225 LT
Isotope injection left breast, 38792 LT, 38525 LT,
left breast lumpectomy, (THIS WAS DEEP) I had prevously stated CPT 19301 but didn't have OP note, check 19302 LT.

Please someone tell me if this was accepted??????? Trying to help.
This are not fun in any way, I wanted to tear my CPT book in half, tricky tricky....they are...
 

gared111

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Without the full op note it is hard to determine what was done, however, all of my surgeons when doing a sentinel node biopsy use two methods of mapping. If this is the case with your procedure you may want to consider 38900 which is intraoperative lymphatic mapping with dye if this procedure was done. Read your op note and if they say they injected the dye and found the blue nodes this is a billable code. Usually the nuclear med doc's will do the lymphoscintigraphy and the surgeons do the blue dye injection and intraoperative mapping.

Hope this is helpful...
Same here.... I generally bill the 38525 with the 38900 as well (along with the mastectomy or lumpectomy code).
 
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jskalet

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Finally...the answer to the missing code

nancy97 you are my hero! That was the code I was missing! I never would have figured that one out. Finally after months and months I have this note done. So for all you peeps that are still working on it, I wrote down all the codes before I submitted the note. Here they are:

233.0 - dx code
19125 LT
19291 2 units LT
19290 51 LT
38525 51 LT
38792 51 LT
76098 26

Phew! Glad that is done :)
 
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Last Code!

I'm stuck on same case #3: So far, I have these codes...

233.0
19290 51 lt
19291 lt
19125 lt
38792 lt
38525 lt

I'm thinking there is only one more code to this case. Help!! Thx.....
hI. You are missing the code for examining the specimen under xray. Try adding 76098.
Thanks.
AJ
 
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