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19302 or 19301 debate

  1. Default 19302 or 19301 debate
    Medical Coding Books
    Good Morning:

    I am in debate with surgeon regarding report dictated and lack of detail needed to code what the physician is stating they want billed, "even if it is not the letter of the law." "This is the way other dedicated breast surgeons code and bill." The physician codes 38525, 19302 and 14301.

    Trying to leave out the unnecessary details the operative note reflects: .....rt breast incision made low in the right axilla, ......lymph node identified.....sent to pathology and found free of tumor. Right axilla subsequently closed....... In the rt breast .....2 lesions one biopsied in cancer. A curvilinear incison made in rt breast, carried down to subcutaneous tissue. Lumpectomy was done encompassing the 2 masses that were less than 2 cm apaprt. Medial and superficial margins reexcised due to palpably close margins. .........Superior and inferior breast flaps raisded of approx 30 cubic centimeters in each direct..........closed in the midline. Subcutanious tissue closed.

    I don't believe 19302 mastectomy with axillary lymphadenectomy is supported since there is no mention of excision of the node chains consisting of nodes between superficial pectoralis major and pectoralis minor as well as axillary nodes. The physician argues that was done with the original exicison of the node fo rbiopsy (38525). I believe this excision of nodes would be separate from the sentinel node(s) removed earlier and sent for biopsy.

    Am I taking the CPT book and Coders Desk Reference too literal?


  2. Default 19302
    In order to report 19302 it must be a complete axillary dissection of all sentinel nodes. Were dyes or tracers used to mark the node(s)? There is also the issue of if any muscle was removed or not? There would be a different code for use in musculature removal.

    I would ask your physician to read through the CPT Assistant September 2008, Volume 18, Page 5, and after reading discuss with them to see if you can come to an agreement.

    Hope that helps.

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