# chest wall mass



## codedog

Patient had  an excision of chest wall mass. Doc office wants to bill 11403 , I think they may be wrong. I think it may be 21555 ,not sure though. it said that an incision was carried down through skin  and subcutaneous , and that the  mass was taken all the way down to fascia, .Does that mean  mussculoskeletal system. Path report came back as infliltrating  ductal carcinoma.  





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POSTOPERATIVE DIAGNOSIS:  Breast CA with a chest wall mass.
OPERATION:  Excision of chest wall mass.

ANESTHESIA:  Local.
PROCEDURE IN DETAIL:
The patient was taken to the operating room, placed on the operating table in the supine position and under adequate local anesthesia was prepped and draped around her chest in the usual sterile fashion.  Incision was made with an ellipse of tissue around the area of concern and carried down through the skin and subcutaneous tissue after it had been infiltrated with 1% lidocaine and 0.25% Marcaine 50:50 solution.  Superior and inferior flaps were formed.  Mass was taken all the way down to the fascia and sent to Pathology for analysis.  Hemostasis was obtained with electrocautery.  The wounds were then closed in layers with absorbable suture.  Steri-strips were applied as well as a bandage.  The patient was awakened and transported to the room in satisfactory condition.
Thanks


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## surgonc87

21555 is correct

MS


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## codedog

21555 yes but the only thing that concerns me was path report said skin not soft tissue. does make a difference?


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## nlbonn

Can you post the path results please?
Thanks.


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## ASC CODER

When it states "These tumors orginate from the dermis or adnexal structures and are not considered soft tissue tumors, even though they may protrude into subcutaneous tissue"

an easy way to tell the difference.... If it starts ON the skin and goes as deep as subq then its the integumentary codes

If it Starts or is below skin a example lipoma then it is the musculoskeletal system


hope that helps


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## codedog

sure 

Gross exam- received is an ellipse of tan -white skin and underlying fatty tissue measuring  2.0 x1.8 x1.2 cm .Respresenative  sections are sumitted in one cassette. 
  MICROSCOPIC  DESCRIPTION

Sections showportions of skin. Within the dermis and subcutaneous adipose tissue are clusters of malignant cells. They show moderate varation in size and shape. Thery are present mostly in solid nests. Seven mitoses are seen in ten high power fields. This qualifies  as Gade 2. This patient with history of breast b carcinoma and this could   represent either recurrence or new primary. The tumor is present at the coagulated edge of the tissue. Perineural invasion identified .

dx- chest wall mass 
-Carcinoma compatible  infiltrating ductal carcinoma


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## codedog

21555?


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## ASC CODER

I would do 21552 due to it being 5.0 in total,

2.0 X 1.8 X 1.2 = 5.0


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## codedog

doc office told me to use 11603 not sure if I AGREE


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## ASC CODER

what dx code are you using?


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## codedog

174.9 ?


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## m.j.kummer

CPT 21552 due to size with ICD-9 code 199.0 because path is not clear as to new primary or recurrence.


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## codedog

thanks


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