# Plastics - Excision of redundant skin



## Mrs.Estrada (Sep 16, 2015)

Hello all,
My Plastic surgeon and I are going back & forth on the appropriate code to select on the following case:

*very pleasant woman who had previously undergone bilateral skin sparing mastectomies and tissue expander reconstruction. She suffered an infection which necessitated removal of the tissue expanders. She wished to not pursue further reconstruction and wished to have the skin of the breast excised. She was advised the risks and benefits of the procedure. After a lengthy discussion, she understand that this will limit her reconstructive options in the future if she changes her mind. She decided to go forward with the surgery. She was brought to the operating room, identified with correct name, medical record number, placed supine position, intubated, prepped and draped in normal sterile fashion. Before the procedure started, she was identified in a time-out with correct name, medical record number, and surgical site. Procedure started with injecting 0.25% Marcaine with epinephrine. Bilateral IMF incisions and then excising the redundant skin flap and excising residual breast capsule decreased seroma formation. The skin and soft tissue was then elevated off the underlying pectoralis major muscle. Hemostasis was obtained, and then this was stretched and redraped to perform flap coverage over both breasts. Dog ears were excised laterally on both sides and medially, completing our incision across the chest. After hemostasis had been obtained, the skin and subcutaneous tissues were then closed in layers with absorbable sutures. *

He suggest 19380 -50 for bilateral breast revision however I disagree and suggested 15839 - Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area. I also discussed the case with another collegue and an ATT (adjacent tissue transfer) code was suggested. Please help, any & all thoughts are appreciated


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