Lt Breast Lumpectomy and axillary lymph node dissection

Trendale

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Hello,



Does anyone know if code 19302 can be used for both the lumpectomy and a axillary lymph node dissection?, and what is the difference between that code and 38745? Should it be coded separate? What has to be stated for a complete axillary lymphadenectomy? Thanks!
 

Jarts

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19302 includes the axillary lymphadenectomy. You will see in the CCI edits that 38745 is bundled into 19302.
 

lcathey@smsc.org

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Need help coding this please

Dr. is suggesting 38745, but hospital coded 19120. Any suggestions would be appreciated. Thanks!!

ANESTHESIA:

General.




PREOPERATIVE DIAGNOSIS:

Recurrent breast cancer, right chest wall/axilla.




POSTOPERATIVE DIAGNOSIS:

Recurrent breast cancer, right chest wall/axilla.




PROCEDURE PERFORMED:

Excision of recurrent breast cancer, right axilla.




FINDINGS:

At the lateral edge of the previous mastectomy scar, along the anterior axillary line, at the border of the pectoralis major, there was a firm, approximately 2 cm nodule that had been previously biopsied and confirmed to be recurrent breast cancer. The nodule was contained within the subcutaneous tissue and did not appear to involve the musculature of the chest wall. There was some scarring inferiorly along the chest wall from the previous surgical procedure, but superior in the axilla, there were several enlarged lymph nodes that had intact capsules and appeared reactive. The largest measured about 2 cm with the smallest about 1 cm each.




DESCRIPTION OF PROCEDURE:

After induction of adequate general anesthesia and with the right arm abducted, the right axilla and chest wall were prepped and draped in a sterile fashion. An elliptical incision, beginning at the lateral edge of the old mastectomy scar, was made sharply and carried out transversely into the axilla. The incision was carried down sharply to the chest wall, where the mass and surrounding normal subcutaneous tissue were excised.




During this portion of the dissection, the enlarged lymph nodes were noted, and these were removed completely without obvious opening of the clavipectoral fascia. The wound was irrigated and hemostasis secured. A 10 mm Blake drain was placed through a separate percutaneous site into the wound, which was closed at the subdermal layer with a series of interrupted 2-0 Monocryl sutures. The skin was closed with running 4-0 Vicryl in an intracuticular fashion, and Steri-Strips and a bulky gauze dressing were applied.




Final needle, lap, sponge, and instrument counts were reported as correct. The patient tolerated the procedure well and was taken to recovery in stable condition.
 
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