AR2728
Expert
Breast procedures really confuse me and this one has me stumped on the correct codes to bill. Surgery was performed at the hospital and their coder used 38525, 11602, and 12031This does not seem correct to me. However, she is more familar with breast procedures than I, so I wanted an experts opinion.
DIAGNOSIS: History of stage II left breast CA.
PROCEDURE: Left sentinel lymphadenectomy with re-excision of site of previous breast cancer, inferior quadrant of left breast.
She then had 3 cc. of isosulfan blue injected beneath the nipple areolar complex. The breast was massaged for 5 minutes and then the breast and axilla were prepped and draped in the usual sterile fashion. Once this was done, using the radionuclide counter, the proximal site of this sentinel lymph node was identified and then a 3 cm. curvilinear incision was made at the inferior extent of the left axillary hairline and carried to the subcutaneous tissue down through clavipectoral fascia to the level of the axilla. The
sentinel lymph node was identified both with blue dye and with an in vivo count of 4,024. Sentinel lymphadenectomy was done with removal of a segment of lymph nodes that were taken out and hemostasis was achieved with 3-0 silk ties and electrocautery. Ex vivo count measured 4,859. Background count was 129 after completion. This was found to be acceptable and therefore copious irrigation of the axilla was done with water. The incision was then closed in 2 layers using 3-0 Dexon to approximate the clavipectoral fascia and skin was closed with subcuticular placed interrupted 3-0 Dexon sutures. Once this was completed, attention was directed to the left breast inferior quadrant where the previous incision was made. This incision was re-opened with a #15 Bard-Parker blade. Dissection was carried down to the subcutaneous tissue down to the site of the scar from the previous surgery and this scar with some port ion of muscle was excised and submitted for pathological evaluation. Hemostasis was achieved with electrocautery. The muscle
fascia was then reapproximated with interrupted 3-0 Dexon sutures and skin was closed...
DIAGNOSIS: History of stage II left breast CA.
PROCEDURE: Left sentinel lymphadenectomy with re-excision of site of previous breast cancer, inferior quadrant of left breast.
She then had 3 cc. of isosulfan blue injected beneath the nipple areolar complex. The breast was massaged for 5 minutes and then the breast and axilla were prepped and draped in the usual sterile fashion. Once this was done, using the radionuclide counter, the proximal site of this sentinel lymph node was identified and then a 3 cm. curvilinear incision was made at the inferior extent of the left axillary hairline and carried to the subcutaneous tissue down through clavipectoral fascia to the level of the axilla. The
sentinel lymph node was identified both with blue dye and with an in vivo count of 4,024. Sentinel lymphadenectomy was done with removal of a segment of lymph nodes that were taken out and hemostasis was achieved with 3-0 silk ties and electrocautery. Ex vivo count measured 4,859. Background count was 129 after completion. This was found to be acceptable and therefore copious irrigation of the axilla was done with water. The incision was then closed in 2 layers using 3-0 Dexon to approximate the clavipectoral fascia and skin was closed with subcuticular placed interrupted 3-0 Dexon sutures. Once this was completed, attention was directed to the left breast inferior quadrant where the previous incision was made. This incision was re-opened with a #15 Bard-Parker blade. Dissection was carried down to the subcutaneous tissue down to the site of the scar from the previous surgery and this scar with some port ion of muscle was excised and submitted for pathological evaluation. Hemostasis was achieved with electrocautery. The muscle
fascia was then reapproximated with interrupted 3-0 Dexon sutures and skin was closed...