Wiki Non-healing breast wound following Mastectomy/Reconstruction

[willicoxj]

Patient with history of left breast cancer and a non-healing breast wound. Underwent bilateral skin sparing mastectomy with tissue expander placement a month and a half ago. She has developed an infection in her left breast and now no longer wishes to move forward with reconstruction and wants expander removed. The Dr. removes the expanders, performed an open capsulectomy on the bilateral breasts. What I am stuck on at this point is the patient had the mastectomy flaps removed on both of her breasts and advanced down to provide a smooth contour with the chest wall. What CPT is most appropriate for this portion of the procedure? Dr. wants me to use 13101 & 13102(x13). I am not sure this is the proper code selection but I honestly cant seem to find anything that will help direct me to another code that better describes this part of the procedure. I would love someone's input.

Thanks!

 

[willicoxj]

Follow up

I searched and searched about this yesterday. There really isn't a code that describes this procedure I thought maybe 15839 (excessive skin excision), or 19380 (reconstructed breast revision) but the breast has only just started being reconstructed. Since this is technically a chronic non healing wound we decided to go with what the dr. selected and use 13101 and 13102 since this is technically a complicated wound closure. Unfortunately, this doesn't account for the skin excision, but I really don't think there was another option.

 

[bostonmom]

Rearrangement

What about using codes like 14000, 14001 or 14301,14302 depending on the size of the tissue rearrangement? I would recommend keeping an eye on that claim, if it gets denied then maybe try of these codes.