# Re-excision for margins



## rwinkfield@tds.net (Sep 27, 2013)

We have a good discussion going in my office about the correct CPT code this one:

".... is a 71-year-old female who underwent needle localized surgical excision of  a biopsied mass which showed ADH.  The final pathology came back as DCIS (small focus intermediate grade).  The patient was discussed on Friday with multidisciplinary tumor board.  I discussed her case with the pathologist, radiologist as well as the oncologist.  We decided that additional margins werre indicated given the nature of the DCIS. This was to ensure adequate surgical clearance of the margins." (This is quoted from the note.)

3 large (the smallest was 4.2 x 2.1 x 1.8 cm) excisions were made. Path came back with 2 segments benign. 3rd biopsy showed "fibrocystic change with a focus of atypical ductal hyperplasia."  

We decided CPT 11606 doesn't fit (no malignancy).  11406 (w/ intermediate closure), 19120, and 19301 are all part of the discussion.  We have reason not to choose any of these, also.  We would welcome comments/opinions.


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## BEARDOG (Sep 27, 2013)

rwinkfield@tds.net said:


> We have a good discussion going in my office about the correct CPT code this one:
> 
> ".... is a 71-year-old female who underwent needle localized surgical excision of  a biopsied mass which showed ADH.  The final pathology came back as DCIS (small focus intermediate grade).  The patient was discussed on Friday with multidisciplinary tumor board.  I discussed her case with the pathologist, radiologist as well as the oncologist.  We decided that additional margins werre indicated given the nature of the DCIS. This was to ensure adequate surgical clearance of the margins." (This is quoted from the note.)
> 
> ...



I am assuming it was breast excisions that were done.  That being said if a larger resection is done with attention to  margins then 19301 : Mastectomy, partial  would be indicated for the DCIS (icd 233.0) as it is described as ..."The physician excises a breast tumor and a margin of normal tissue by performing a partial mastectomy by making an incision through the skin and fascia over a breast malignancy and clamping any lymphatic and blood vessels. The physician excises the mass along with a *margin or rim of healthy tissue.* This procedure is often referred to as a segmental mastectomy or a quadrantectomy, but is also called a lumpectomy.  You would still use DCIS as the diagnostic code for the "lumpectomy" as this is the reason the return to surgery was done and it would be billed with a 58 modifier for staged procedure. I am also assuming it was done at a later date that the original diagnosing biopsy.  If *three seperate incisions *were made, the other two being breast biopsies it would be appropriate to code them as 19120 or 19125 (as appropriate) with 59 modifiers as three *seperate incisions with seperate closures were made *(if i am understanding the sequence correctly). I would also make sure that you included V10.3 as a secondary code for the two other biopsys that were done. It would not be appropriate to bill for the intermediate closure with either the partial mastectomy or biopsy codes as it is included in the procedure.  If these were not breast procedures then I am way off base here and hope this does not lead to further confusion.


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## rwinkfield@tds.net (Sep 30, 2013)

Thank you very much! That got me thinking in a new direction. I appreciate your time.


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