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nipple and areola sparing mastectomy

Vicky Posted Fri 18th of March, 2011 14:44:38 PM

What is the correct code for a nipple and areola sparing mastectomy. I have used 19304 in the past but am second guessing myself because the incision is around the border of the nipple and then underneath the areolar complex as opposed to the inframammary crease of the breast.

SuperCoder Answered Mon 21st of March, 2011 04:02:34 AM

Please provide the details of the procedure.

Vicky Posted Tue 22nd of March, 2011 17:55:35 PM

OPERATIVE FINDINGS: The implant occupied most of the lateral part of the breast. The pectoralis muscle was retracted medially with the implant mostly surrounded by capsule with some muscle anterior to the medial half of the implant.

OPERATIVE PROCEDURE: With the patient in the supine position after being appropriately identified on the operating table, skin incision outlines were made. The previous markings by Dr. Normington were followed with a nipple sparing approach with the incision going across the upper border of the nipple and then underneath the nipple areolar complex. The incision was made proximally 12 cm in length and carried down into the subcutaneous tissues, dissected well beneath the areola and nipple, leaving a good margin of tissue. We recognized preoperatively that there would be some breast tissue remaining in this portion so as to prevent necrosis of the nipple and areola. The lower flap was then elevated down to the chest wall. Laterally I got on top of and ultimately into the capsule around the implant and this was opened and then the implant was extruded and passed off the field. The lower flap was completely elevated, dissecting in the areolar plane between the subcutaneous tissue and breast tissue. The upper flap was then elevated in the same fashion and the breast tissue was then dissected off of the underlying pectoralis muscle. This was very difficult in the area of the capsule and scarring around the previous partial reconstruction and pectoralis muscle was noted to be significantly elevated, but with very restricted space beneath it from the previous scarring. I got into the muscle in 2 places at the inferior edge and this was easily closed with interrupted horizontal mattress sutures of #0 Vicryl. The breast was then passed off the field. All bleeding was controlled with electrocautery. It should be noted the dissection was all done with the harmonic focus device. No cautery was used. The field was then thoroughly irrigated with saline and the case was turned over to Dr. Normington for reconstruction.

cc:

SuperCoder Answered Wed 23rd of March, 2011 08:37:11 AM

In 19303, a modification of the simple mastectomy, skin and nipple may be spared, but all subcutaneous breast tissue is removed. So, we can code 19303.

Vicky Posted Wed 23rd of March, 2011 14:43:01 PM

Thank you.

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