Muscle Biopsy 20205


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Orthopaedic Oncology doctor did a biopsy for the intravascular contents before the vascular surgeon performed a vascular bypass and we normally bill the biopsies for the oncology MD's. She is using procedure code 20205 for deep muscle biopsy and need to confirm the procedure code. Additional procedure code is 27364 for the excision of the mass and 35721 Exploration of femoral artery:

After obtaining adequate general anesthesia the appropriate lines were placed by anesthesia.  A Foley catheter was placed.  The patient's left lower extremity was prepped and draped in a sterile fashion.  There is an obvious mass in the abductor compartment.  The incision was made over this area ellipsing out the previous biopsy tract.  Skin flaps were raised around mostly the sartorius and gracilis.  The sartorius and gracilis were transected approximately 2 cm proximal to the mass.  On the distal side the same thing was done.  We then made a way around medially and laterally.  We identified the femoral artery proximal and distal to the mass.  The traced it up to the level of the mass and became apparent it was adherent and going into the mass.  At that point Dr. Lum was called in from vascular surgery.  He attempted to get the artery away from the tumor but it was apparent that the tumor invaded into the artery.  The decision was made then to do a bypass.  That part of the case will be dictated by him.  The artery was cut.  The vein was transected along the length of the tumor. There was abundant thrombus in the vein. Contents from the artery and vein were went to pathology. Frozen section was negative for malignancy.The rest of the soft tissue was freed and the mass was delivered en bloc from the patient and intact.  It measured 7 cm.  Dr. XXX performed the vascular bypass. Plastics performed the closure.  I was present during the resection there were no complications.