Lumpectomy Coding Help

amandapreno

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Looking for opinions on the following procedure:

Post Op DX: L. Breast Carcinoma

Procedure: Left needle localized lumpectomy, sentinel lymph node mapping and biopsy.

Needle localization and technetium radiotracer injection were performed in the nuclear medicine department. Patient was transferred to the operating room where she identified site and procedure. In the supine position, intravenous sedation was delivered. Left breast and axilla were prepped and draped in the usual sterile fashion. All tissues were anesthetized with 1% bicarbonate and Xylocaine plain and attention was first turned to the axilla where a curvilinear incision was made inferior to the hairline of the left axilla overlying the area of highest external gamma count. Dissection was carried through clavipectoral fascia using the cautery. One sentinel node packet was encountered and excised. After its removal, there was a greater than four fold reduction to background count. Frozen section analysis of the node was negative. Hemostatis was verified. Wound was closed with topical marcaine 0.5% plain was applied on deep and subcutaneous tissue and a running subcuticular 4-0 PDS on skin.

Next, attention was turned to the lumpectomy where a curvilinear incision was made overlying the appropriate area. Skin flaps were elevated with the catery and the guide wire was delivered into the central portion of the wound. A wide lumpectomy was performed using the cautery. Specimin was oriented for the pathologist and specimin radiography confirmed the presense of the mass and clip within it. Additional margins were taken for permanent analysis and were oriented. They were taken from the posterior, medial, superior, lateral, inferior, and anterior dimensions.

I have this coded right now as 19302-RT and 38900.
 
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