# needle localized partial mastectomy and sentinel nose excision



## efuhrmann (Sep 21, 2009)

Can I code all three excisions?  And what about the clip placement on the excised tissue?  "the breast was injected behind the areola with the meth blue...an elliptical incision was made...the thick part of the wire was already evident through the skin.  The dissection was carried down to the pectoralis mfascia, and after the tissue was excised, margin markers were placed on it, and it was sent to mammography where the clip was noted to be in the center of the tissue removed.  The area of the sentinel node was then identified using the Neoprobe.  Just underneath the axillary fascia a node was identified which was faintly blue in color.  Once it was excised had a target count of 121.  Additional radioactivity(via Neoprobe) traced to two other nodes.  Once these were removed, no additional radioactivity.  Attention was then turned to the area of the breast wound.  By this point, the pathologist had returned info that the margins were clear around the biopsy cavity and no obvious residual malignancy present.  The breast parenchyma was elevated for the pectoralis fascia circumferentially with cautery...multiple sutures to contour the breast...to approximate the skin.  Dressings, SurgiBra etc."  THANK YOU


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## Lisa Bledsoe (Sep 21, 2009)

*38525*

Hi Liz - I think if you are reporting 38525 it can only be once even if 3 nodes are excised; based on the description in CPT "node(s)" and because these appear to be of the same lymphatic chain.


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## sundaey (Sep 21, 2009)

Hello there,
I would code the partial mastectomy, 19301, the methyl blue injection (if the doctor performed it), 38792, then 38525 for the axillary nodes. You can only code for placing the clips if it was done during a breast biopsy, not a mastectomy. From what my surgeon's have told me, those clips are usually placed by a radiologist.


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