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chest wall mass

  1. #1
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    Default chest wall mass
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    Patient had an excision of chest wall mass. Doc office wants to bill 11403 , I think they may be wrong. I think it may be 21555 ,not sure though. it said that an incision was carried down through skin and subcutaneous , and that the mass was taken all the way down to fascia, .Does that mean mussculoskeletal system. Path report came back as infliltrating ductal carcinoma.



    POSTOPERATIVE DIAGNOSIS: Breast CA with a chest wall mass.
    OPERATION: Excision of chest wall mass.

    ANESTHESIA: Local.
    PROCEDURE IN DETAIL:
    The patient was taken to the operating room, placed on the operating table in the supine position and under adequate local anesthesia was prepped and draped around her chest in the usual sterile fashion. Incision was made with an ellipse of tissue around the area of concern and carried down through the skin and subcutaneous tissue after it had been infiltrated with 1% lidocaine and 0.25% Marcaine 50:50 solution. Superior and inferior flaps were formed. Mass was taken all the way down to the fascia and sent to Pathology for analysis. Hemostasis was obtained with electrocautery. The wounds were then closed in layers with absorbable suture. Steri-strips were applied as well as a bandage. The patient was awakened and transported to the room in satisfactory condition.
    Thanks

  2. #2
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    21555 is correct

    MS

  3. #3
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    NEW ORLEANS
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    Default
    21555 yes but the only thing that concerns me was path report said skin not soft tissue. does make a difference?

  4. #4
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    Can you post the path results please?
    Thanks.

  5. #5
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    When it states "These tumors orginate from the dermis or adnexal structures and are not considered soft tissue tumors, even though they may protrude into subcutaneous tissue"

    an easy way to tell the difference.... If it starts ON the skin and goes as deep as subq then its the integumentary codes

    If it Starts or is below skin a example lipoma then it is the musculoskeletal system


    hope that helps
    LG CPC,CASCC

  6. #6
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    sure

    Gross exam- received is an ellipse of tan -white skin and underlying fatty tissue measuring 2.0 x1.8 x1.2 cm .Respresenative sections are sumitted in one cassette.
    MICROSCOPIC DESCRIPTION

    Sections showportions of skin. Within the dermis and subcutaneous adipose tissue are clusters of malignant cells. They show moderate varation in size and shape. Thery are present mostly in solid nests. Seven mitoses are seen in ten high power fields. This qualifies as Gade 2. This patient with history of breast b carcinoma and this could represent either recurrence or new primary. The tumor is present at the coagulated edge of the tissue. Perineural invasion identified .

    dx- chest wall mass
    -Carcinoma compatible infiltrating ductal carcinoma

  7. #7
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    NEW ORLEANS
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    21555?

  8. #8
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    I would do 21552 due to it being 5.0 in total,

    2.0 X 1.8 X 1.2 = 5.0
    LG CPC,CASCC

  9. #9
    Location
    NEW ORLEANS
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    954
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    doc office told me to use 11603 not sure if I AGREE

  10. #10
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    what dx code are you using?
    LG CPC,CASCC

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