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Any input on code selection...

louise Posted Thu 16th of April, 2020 13:16:17 PM
. Left breast skin sparing total mastectomy.19303 . Injection of left breast for identification of sentinel nodes. 38900 . Left axillary sentinel lymph node biopsy 38525 . Right total skin sparing mastectomy. 19303 . Right breast injection of dye for identification of sentinel node. 38900 . Right axillary sentinel lymph node biopsy. 38525 . Right axillary dissection. . Bilateral breast reconstruction with tissue expander placement 15777 rt/lt . Bilateral lateral reinforcement of breast pocket with acellular dermal matrix placement 19357
SuperCoder Answered Fri 17th of April, 2020 07:18:07 AM

 

Hi Louise,

 

Thank you for your Question.

 

The above-provided documentation seems like just a description of the procedure. We are suggesting codes as per the description provided. Actual code may vary as the appropriate code selection would be based upon the detailed operative notes. Kindly correlate with your operative note.

 

CPT® code 19303 (Mastectomy, simple, complete) seems appropriate for Left breast skin-sparing total mastectomy and Right total skin-sparing mastectomy. You can append an appropriate modifier like 50 or LT/RT.

 

CPT® code 38900 is used for Injection of left breast for identification of sentinel nodes, CPT® code 38792 can be used instead of 38900. As 38900 is used for Intraoperative identification. 38792 is for the radioactive tracer that is usually injected in a different locale before surgery. The 38900 is used when the injection of a non-radioactive dye that the surgeon injects during surgery.  38792 Injection procedure radioactive tracer for identification of sentinel node. For injection of radioactive tracer for identification of sentinel node use 38792-50. Since CPT® code 38900 is an add on code choose appropriate primary code for service performed. Kindly correlate with your operative note.

 

Left axillary sentinel lymph node biopsy and Right axillary sentinel lymph node biopsy CPT® codes 38500 or 38525 can be used. Axillary lymph nodes categorized into three levels. Level II and III lymph nodes are always deep (38525). Level I nodes may be either deep or easily palpable (38500). Therefore, carefully check your document for lymph node depth.

 

CPT® code 15777 can be used for implantation of biologic implant for Bilateral breast reconstruction with tissue expander placement. For bilateral breast procedure, report 15777 twice using LT/RT modifier. Do not report modifier 50 in conjunction with 15777.

 

CPT® code 19357 seems appropriate for Bilateral lateral reinforcement of breast pocket with acellular dermal matrix placement.

 

Hope that Helps!

 

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