# 19120 ?



## codedog (Nov 30, 2010)

. would this be a 19120 or 14000 series
note path report came back a breast mole  -squamous cell carcinoma in  situ ?
patient did have a history of breast cancer 
 doc office  says use cpt code  11101- i disagree 

POSTOPERATIVE DIAGNOSIS:  Left breast mole
PROCEDURE:  Excision and biopsy of left breast mole.
ANESTHESIA: MAC.
ESTIMATED BLOOD LOSS: Minimal. 
CLINICAL HISTORY: This is a-year-old female with a history of breast cancer with a mole on her left chest which has recently begun intermittently bleeding spontaneously. 
PROCEDURE IN DETAIL:
The patient was brought into the operating room, placed on the operative table in the supine position.  The left breast was prepped and draped in a sterile fashion.  Then 5 cc of 1% lidocaine with epinephrine was injected for local anesthesia.  An elliptical incision was made to excise the left breast mole with grossly negative margins.  Hemostasis was achieved with electrocautery. The wound was inspected and found to be hemostatic.  The skin was closed with 4-0 nylon simple and horizontal mattress sutures.  Sterile dressing was applied.  The patient tolerated the procedure well 

thanks


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## CVelez (Dec 1, 2010)

I think this should be 11600-11606 depending on size of the lesion.  

Charla


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## nsteinhauser (Dec 2, 2010)

One could argue that since it is in the anatomical area of the 'breasts' that you could use the 19xxx code.  Also supporting that thought - some breast cancers originate deep in the breast tissues but only show up in the SKIN of the breasts.  19120 includes excision of  'aberrant breast tissue' in it's definition.  

This is question I've had, too..... skin 'lesion' excisions should be the integumentary codes, yes, but what happens if that skin lesion etiology is 'something's wrong in the breast'?


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## codedog (Dec 6, 2010)

OK if  I go with 1160x series but size of mole is not dictated operative report   . Now on path report  said received  is an  ellipse and underlying fatty tissue meauring  3.0 x 1.5  x 1.5 cm. Sections  of skin show squamous cell carcinoma  in -situ. The tumor  pushes into the  dermis but does not apperar to invade it. cAN i usev 3.0 as size?


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## nsteinhauser (Dec 7, 2010)

Specimens sometimes shrink in the formalin - so if pathology measures 3cm, the actual size of the incision (lesion plus margins) could have been greater.  Best to ask for documentation of size from the surgeon.

If surgeon can't or won't document size of lesion + margin, then you have to go with the pathology.


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## codedog (Dec 7, 2010)

nsteinhauser based on path report would you code it as  19120 ?


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## bethh05 (Dec 9, 2010)

I agree with CVelez.


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