# Lumpectomy with complex closure and tissue rearrangement



## mbdonn (Oct 4, 2012)

Hello

I was wondering if anyone had this situation and what they did and are they getting paid

My doctor performed a lumpectomy that created a void that was 8cm wide by 8cm long, he harvested from 4 quadrants, medial, lateral, superior, and inferior V-shaped flaps of breast tissue and approximated them at the middle.  He put them together with multiple interrupted Vicryl 2-0 stitches, then apporoximated the subcutaneous tissue with a single continuous layer of Vicryl 3-0, and the skin was closed with Vicryl 4-0 subcuticular and applying a layer of Dermabond.  I am coming up with 
14301, and 14302 becaue the defect was so large.  However these codes state that they include the excision of the lesion and therefor I could not use the 19301 code with it.  But if you used this type of complex closure and the wound was smaller. say less then 10sq cm which is cpt code 14000 then the RVU's for this code (which includes excision of the lesion) is less RVU's then the lumpectomy.  This does not make sense to me.  

Can anyone help or advise?  It would be much appreciated.

Thanks, 
Melissa, CPC


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## hjkotlar (Oct 4, 2012)

Code 19301 is applicable if only 25% of breast tissue is excised.  Have you looked at 19304 or 19303?


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