Rebecca Posted Thu 01st of August, 2019 14:22:17 PM
Breast cancer, bilateral metachronous tumors
Status post bilateral mastectomy with bilateral sentinel lymph node biopsy, on the left in 2016, on the right and 2019
Redundant skin and subcutaneous tissue of the trunk, bilateral
Desired mastectomy revision, bilateral
(1) redundant skin and subcutaneous tissue of the torso
(2) breast cancer metachronous
PROCEDURE : Mastectomy revision with resection of redundant skin and subcutaneous
tissue of the torso with adjacent tissue transfer: on the left dimensions
being approximately 5 x 5 cm superiorly and inferiorly, total of 50 cm² on
the left, on the right 5 x 5 cm for a total of 25cm² summation total of 75
cm². SPECIMEN REMOVED: Left mastectomy revision with a suture in the supero-lateral lateral
position, dogear left superior, dog ear left inferior
Right mastectomy revision with a suture in thesupero-lateral position,
Surgery commenced on the LEFT. An elliptical incision was created to excise her previous mastectomy scar and surrounding skin and subcutaneous tissues. Skin and subcutaneous tissues were dissected all the way through to the chest wall where a chronic seroma was identified, and drained. The specimen was removed, suture placed superiorly and laterally, out of body time noted, and forwarded to pathology. The seroma pseudo-sac was obliterated with both gauze abrasion as well as cautery obliteration. A 19 French round Blake drain was brought into position out through separate stab incision sutured to the skin with a 2-0 nylon. Redundant tissue at the lateral aspect of the wound was identified, and resected using a VY advancement flap creating superior and inferior dogears on the left with dimensions of 5 x 5 cm each. Wound was checked for hemostasis, irrigated and aspirated and skin closed with skin clips subcutaneous tissues were re-approximated with a 3-0 Vicryl, skin closed with skin clips. Surgical site was covered with a sterile towel and attention was turned to the right.
Once again an elliptical incision was created to excise her previous mastectomy scar and surrounding redundant skin and subcutaneous tissues. Dissection was carried all the way through to the chest wall where only laterally on the RIGHT was a chronic seroma identified, it was smaller than that on the left. The specimen was resected, and out of body time noted, suture placed in a superior and lateral position, forwarded to pathology for permanent histologic diagnosis. The seroma pseudo-sac once again was obliterated with gauze debridement as well as cautery obliteration a 19 French round Blake drain was brought into position out through separate stab incision sutured to the skin with a 2-0 nylon and once again a YV advancement flap on the right was created although in this case there was only a superior dog ear, and it was forwarded to pathology. Wounds were checked for hemostasis, irrigated and aspirated, subcutaneous tissues re-approximated with a 3-0 Vicryl skin closed with skin clips sterile dressing applied. Patient tolerated the procedure without difficulty and transferred to the recovery room in stable condition
Dx. C50.211- Malignant neoplasm of upper-inner quadrant of right female breast
L98.7- Excessive and redundant skin and subcutaneous tissue
L76.34-Postprocedural seroma of skin and subcutaneous tissue following other procedure
Z17.0 - Estrogen receptor positive status
14301-LT (50 sq cm)
14001- RT (25 sq cm)
What about the removal of the redundant skin and subcutaneous tissue??? –would I look to CPT codes 13101-13102 or 12001-12007 or 12031-12037…. or 19301 possibly? The insurance is Medicare-the path report is still pending TY
SuperCoder Answered Fri 02nd of August, 2019 05:37:39 AM
nbsp AAE does not provide coding reviewing for operative reports and chart notes SuperCoder offers SuperCoding on Demand SOD http www supercoder com coding-answers coding-on-demand for coding of an operative report or chart note and you can contact - or e-mail customerservice supercoder com for more information nbsp In addition...
Rebecca Posted Mon 12th of August, 2019 10:55:39 AM
I wasn't asking you to code the Op Report I was just providing all the information to you I have gotten controversial coding info when it comes to coding for scar revisions on previous mastectomies I was hoping for some clarity on this matter Am going to code this as...
SuperCoder Answered Wed 14th of August, 2019 07:44:45 AM
Hi Rebecca Hope you are keeping well You are right when only scar revision is performed then it is suggested to use a complex repair code out of - Also as you described that it is mentioned about the adjacent tissue transfer then do not bill CPT codes and because...
Rebecca Posted Wed 14th of August, 2019 11:10:59 AM
Just want to make sure I have complete clarity on this Regarding my physicians Op Report the correct coding would be ATT R Left breast sq cm would be CPT code -LT and ATT R Right breast sq cm would be CPT code -RT and x code C and L...
SuperCoder Answered Fri 16th of August, 2019 05:40:07 AM
Hi Rebecca Hope you are keeping well Since the size of ATT at the left side breast is Sq CM then CPT ATT trunk can be used for first Sq CM and CPT for further Sq CM appending modifier LT with both the codes On the other hand for the...