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Lumpectomy vs Excision of Breast Lesion

  1. Question Lumpectomy vs Excision of Breast Lesion
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    The surgeon names all of his breast surgeries as a "Breast Lumpectomy" so I'm not sure what the specifications are to bill the surgery as a lumpectomy or when it is a lesion removal.

    I was coding/billing the surgery as a mastectomy, partial (eg, lumpectomy) but then I noticed that the hospital is billing the surgery as an excision of a lesion so now I'm worried that I am coding them incorrectly.

    Please help!!!

  2. Smile
    This is the lay description from Ingenix for a "lumpectomy or partial mastectomy" 19301:

    "The physician excises a breast tumor and a margin of normal tissue by performing a partial mastectomy by making an incision through the skin and fascia over a breast malignancy The physician excises the mass along with a margin or rim of healthy tissue. This procedure is often referred to as a segmental mastectomy or a quadrantectomy, but is also called a lumpectomy. "

    This is the lay description from Ingenix for a breast biopsy 19120:
    "The physician excises breast tissue for biopsy. The physician makes an incision in the skin of the breast overlying the site of the mass. Skin and tissue are dissected from the site of the defective tissue. The lesion is removed without attention to obtaining clean margins"

    Partial mastectomy or "lumpectomy" are usually done on already diagnosed breast cancers. However, it the surgeon does a breast biopsy which diagnosed cancer and if during the same operative session a partial mastectomy was done it would be coded as a partial mastectomy and not as a biopsy. Back in the day we were allowed to do a biopsy (19120 or 19125) and if cancer was found and a partial or full mastectomy was done it would also be added with a 58 modifier, the same with the sentinel nodes and subsequent node dissection done at the same operative session. Alas, CCI has eliminated that.

    I have however, seen a partial mastectomy done when there was suspicion that there was a malignany present and for whatever reason a previous diagnosis of cancer was not obtained. I am a little uncomfortable with that as partial mastectomy or "lumpectomy" are usually done for malignancies. We would really need to have more information to fully answer your question. I hope this answer was not clear as mud and confuse you more.


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