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nipple areola resection?

  1. Default nipple areola resection?
    Medical Coding Books
    I have an op report for nipple areola resection and wants to use cpt 19350-50 but i really don't think this is right, there was excision of nipple, skin & subq tissue but no nipple reconstructing, but i'm not sure what other code to use instead?

    DX: Carcinoma in situ right & left breast

    Patient is a female who last month underwent prophylactic subcutaneous mastectomies. The patient underwent bilateral subcutaneous mast4ectomy with an uncomplicated course until the pathology report returned that she had bilateral carcinoma in both right and left breasts that was in situ under the nipple areolas. Concurrent to this, the patient had developed a necrosis of skin around the right and left nipple subsequent to application of some ice packs for postoperatively. She had seen a cancer breast surgeon Dr..... who also confirmed the treatment, which should be removed of the bilateral breast expanders and resection of both nipples and accompanying necrotic skin.
    Patient had first a transverse elliptical full thickness tissue excision of the 2cm x 2cm skin on the left nipple areola including skin and subcutaneous tissue. The nipple itself was involved in this elliptical incision and there was normal skin superiorly and inferiorly. The patient then had expander identified and this was removed through the 2cm wound and then the breast pocket, which was cleaned and was irrigated with peroxide, Betadine, and saline. The patient had 7mm drain placed through the lwer chest revised and subsequently the Jackson Pratt drain securd with a 3-0 silk suture. & closed with deep sutures.... Next patient had right breast treated, right breast had a lenticular excision of the nipple. The skin and the specimen sent, which measured in total length 5.5 cm b 3cm. There was encountered a small amount of serous fluid, which had been previously cultured negative and the patient had the expander in this breast pocket also removed. and drain also placed. following this patient then had the skin closed into a deep sutures of 5-0 chromic closing the fat and 5-0 prolene in the skin. The sutures in the right inframammary incision were also removed.

  2. #2
    Charleston, WV
    IMHO 19120 would be the best option. I believe you can also bill for the removal of the tissue expanders.

  3. Default
    You know that's what I was thinking to, but I bill for ASC & I have surgeon's ofc stating it's something else, I don't actually see areola reconstruction, just excision of areola w/skin

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