Tanesha Posted Wed 06th of November, 2019 22:50:37 PM
Skin sparing mastectomy was done previously. Surgery now for revision reconstruction and insertion of delayed breast implants. Now, he excises the left nipple and areola complex due to positive atypical cells which codes to 19301 (diff. incision), but this edits with 19342. Or would the excision be a part of the revision? Op Excerpt: A permanent implant was prepared on the back table and placed into the breast pocket using a Keller funnel. The implant was placed. Capsule was closed using an interrupted 3-0 Vicryl suture. The deep dermis was closed using an interrupted 3-0 buried Vicryl suture and the skin was closed using a running subcuticular 4-0 Monocryl. The nipple and areolar complex on the left was excised sharply using a #10 blade.
SuperCoder Answered Thu 07th of November, 2019 09:42:24 AM
Thanks for your question.
If you choose code 19380 for revision of reconstructed breast then the code suggests that the physician removes excess amounts of tissues, skin, and fats to reshape the breast to look like the contralateral (other) breast. If necessary, a new prosthesis can also be used. Drains are then placed, and the incision site is closed.
The description of code 19380 doesn’t suggest that the excision of nipple and/or areola complex is done.
Code 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions can be billed instead of 19301 which is billed when surgeon suspects malignancy, however, and removes the tumor along with a significant portion of surrounding tissue (at least a 1-cm margin of healthy tissue) for local treatment and control, the mastectomy code 19301 is more appropriate. Generally, this would include removal of at least 25 percent of the breast tissue (that is, a quadrectomy). In this case, the surgeon would not expect to have to remove more tissue even if the pathology report does indeed reveal malignancy.
Code 19380 is a column 2 code for 19342, but you may use a CCI-associated modifier to override the edit under appropriate circumstances. Medical necessity should also be established with the procedure performed.
Please feel free to ask if you have any questions.