Hi There! I am hoping someone can help me correctly code this procedure. We came up with 19318-50, 13101 and 13102 but I'm not sure since the Oncoplastic portion was only done on one breast.
PREOPERATIVE DIAGNOSIS:
Left breast neoplasm.
POSTOPERATIVE DIAGNOSIS:
Left breast neoplasm.
PROCEDURES:
Left breast oncoplastic reshaping after lumpectomy, followed by bilateral breast reduction with free nipple graft and 8 em complex closure of axilla.
INDICATIONS:
Patient is a 58-year-old female diagnosed with a left breast neoplasm. She was found to be a good candidate for the above procedure. She was informed of the risks, benefits, alternatives to the procedure. Risks including infection, bleeding, pain, need for additional procedures, damage to nearby structures, unsatisfactory cosmetic outcome. Patient was evaluated and due to the extreme size of her breast, a free nipple graft would be warranted to prevent future complications. She was informed of the pluses and minuses of this procedure. Consent was signed and placed on the chart after her questions were answered.
OPERATION:
Patient was brought to the OR, placed in supine position where general anesthesia was administered. Patient was prepped and draped in standard surgical fashion. While Dr. ____ commenced surgery on the cancer portion of the breast, we started surgery on the contra lateral portion. The preoperative markings were reinforced and all incisions were injected 1% lidocaine with epinephrine. Once this had taken affect, the nipple-areolar complex was taken off the breast using a 45 mm template to outline and then taking the nipple-areolar complex off as a full thickness graft, passing it off the field and placing in a moist gauze. At this point, a 10 blade was used to incise through the dermis along all markings. The lower pole of the breast was resected in its entirety and then the central aspect of the breast was incised along the lateral diagonal line down to the chest wall. This was folded inward on itself to check for breast shape and symmetry. The pocket was irrigated copiously, checked for hemostasis and then closed temporarily. Once Dr. ____ had performed her portion of the case, the noted defect was observed and manipulation of the breast tissue was performed in order to form a pedicle of breast tissue that was slip into the defect. This was after all of the preoperative markings were incised.
The dermis was removed and the nipple graft was taken. The pedicle was secured to the chest wall with a 2-0 Vicryl suture and this breast was temporarily closed. The patient was sat upright. The patient was placed back in a supine position and minor adjustments were made to the cancer portion to mobilize more breast tissue to enable to fill the noted defect. Once this was done, the breasts were temporarily closed. The patient was sat upright and the new position of the nipple position was determined and marked with a 42 mm template. Patient was placed back in supine position. The closure commenced with 3-0 Vicryl in the dermal layer of the vertical incision, a 3-0 180 V -Loc suture in the horizontal limb of the dermal incision. The superficial layer was closed with 4-0 running Monocryl. The area previously marked for the template was epithelialized. The full-thickness skin grafts were evaluated and any excess dermis or adipose tissue was removed. These were then placed on the recipient sites and secured at 4 comers with 5-0 plain gut suture. The periphery was then sutured with 5-0 plain gut suture. Once the grafts were secured in place, a periphery of 2-0 silk sutures were placed in 8 positions around the nipple-areolar graft. A Xeroform bacitracin dressing was placed directly over the grafts and then cotton soaked with mineral oil was placed over this. The previously placed silk sutures were then used to tie over this bulky dressing to form a bolster. Once both bolsters were in place, all areas were cleansed and dried, fluffed gauze placed over the breast and a breast band placed over the patient.
PREOPERATIVE DIAGNOSIS:
Left breast neoplasm.
POSTOPERATIVE DIAGNOSIS:
Left breast neoplasm.
PROCEDURES:
Left breast oncoplastic reshaping after lumpectomy, followed by bilateral breast reduction with free nipple graft and 8 em complex closure of axilla.
INDICATIONS:
Patient is a 58-year-old female diagnosed with a left breast neoplasm. She was found to be a good candidate for the above procedure. She was informed of the risks, benefits, alternatives to the procedure. Risks including infection, bleeding, pain, need for additional procedures, damage to nearby structures, unsatisfactory cosmetic outcome. Patient was evaluated and due to the extreme size of her breast, a free nipple graft would be warranted to prevent future complications. She was informed of the pluses and minuses of this procedure. Consent was signed and placed on the chart after her questions were answered.
OPERATION:
Patient was brought to the OR, placed in supine position where general anesthesia was administered. Patient was prepped and draped in standard surgical fashion. While Dr. ____ commenced surgery on the cancer portion of the breast, we started surgery on the contra lateral portion. The preoperative markings were reinforced and all incisions were injected 1% lidocaine with epinephrine. Once this had taken affect, the nipple-areolar complex was taken off the breast using a 45 mm template to outline and then taking the nipple-areolar complex off as a full thickness graft, passing it off the field and placing in a moist gauze. At this point, a 10 blade was used to incise through the dermis along all markings. The lower pole of the breast was resected in its entirety and then the central aspect of the breast was incised along the lateral diagonal line down to the chest wall. This was folded inward on itself to check for breast shape and symmetry. The pocket was irrigated copiously, checked for hemostasis and then closed temporarily. Once Dr. ____ had performed her portion of the case, the noted defect was observed and manipulation of the breast tissue was performed in order to form a pedicle of breast tissue that was slip into the defect. This was after all of the preoperative markings were incised.
The dermis was removed and the nipple graft was taken. The pedicle was secured to the chest wall with a 2-0 Vicryl suture and this breast was temporarily closed. The patient was sat upright. The patient was placed back in a supine position and minor adjustments were made to the cancer portion to mobilize more breast tissue to enable to fill the noted defect. Once this was done, the breasts were temporarily closed. The patient was sat upright and the new position of the nipple position was determined and marked with a 42 mm template. Patient was placed back in supine position. The closure commenced with 3-0 Vicryl in the dermal layer of the vertical incision, a 3-0 180 V -Loc suture in the horizontal limb of the dermal incision. The superficial layer was closed with 4-0 running Monocryl. The area previously marked for the template was epithelialized. The full-thickness skin grafts were evaluated and any excess dermis or adipose tissue was removed. These were then placed on the recipient sites and secured at 4 comers with 5-0 plain gut suture. The periphery was then sutured with 5-0 plain gut suture. Once the grafts were secured in place, a periphery of 2-0 silk sutures were placed in 8 positions around the nipple-areolar graft. A Xeroform bacitracin dressing was placed directly over the grafts and then cotton soaked with mineral oil was placed over this. The previously placed silk sutures were then used to tie over this bulky dressing to form a bolster. Once both bolsters were in place, all areas were cleansed and dried, fluffed gauze placed over the breast and a breast band placed over the patient.