# Excision After Mastectomy!



## rlcohen76 (Oct 8, 2010)

Patient with history of invasive breast cancer with mets to the lymph nodes who had a Modified Radical Mastectomy has develpoed another mass in the same breast adherent to the implant.

There is a debate as to code this as 19125 or 1140X based on the size.
The arguement for coding from 1140X series is that there is no breast tissue as it was removed in the prev surgery. 

Report states: Sonographic localization of right breast mass. Mass involving the right reconstructed breast area on the upper outer quadrant. Mass was abutting to the pseudocapsule of the breast prosthesis. Mass was approx 1.5cm. partial excision of the pseudocapsule, including the mass was accomplished with reconstruction of the wound including closure. Incision measured approx 3 cm in length and was carried by means of sharp disscetion to the subcutaneous tissue. The psuedocapsule was entered avoiding damage to the implant and then the mass on the segment of the pseudocapsule was removed.


thoughts are greatly appreciated


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## preserene (Oct 8, 2010)

It is a malignant  lesion excision, and so 1160x could be thought of; no matter there is no breast tissue ther.e It is an area of those cells and anything coming out of it is from the precursor cell. It is a malignancy from the site of breast tissue cells. More over it goes for trunk group.

Next, it was already a reconstructed breast and Procedure (done earlier).

I would go for 19380, 19371.  I believe the excision code will be taken care of by the revision code.
Does the revision code necessarily be for normal tissuesw; not necessarily I hope.

Any one who could revise this suggestion I would appreciate. after all, we all are learning by trial and error. It is a field of every one /and /or no Man's land !!!


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## rlcohen76 (Oct 8, 2010)

thank you for the reply but i do not think 19371 or 19380 are correct. A capsulectomy is done when  thick scar tissue "capsule" forms around an implant. Its the bodies way of protecting itself from the impant, like a foreign body. 
Revision of reconstructed breast is done for issues with asymmetry, tissue re-arrangement and sometimes the prosthesis is removed and replaced. Neither of these procedures were performed.

This was not the case, there was a mass that was adherent to the implant, not a malignant skin lesion. 

Thank you for your response! It was very insightful especially since coding can be so subjective!


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## preserene (Oct 8, 2010)

I  am sorry to take up the issue.I was totally away from the fibrosis and scarring / or keloid tendency sort of stuff.. When you said a *MASS (sonographically *diagnosed)at the site of CA breast, the first thing that strick my mind is all about the recurrence. But first of all  I was not aware of the type of  implant  implanted submuscular, sub cutaneous,  from your info. More over I thought the mass was deep sub muscular.
Revision always not nessarily @the normal anatomy.
Yet  another  fact is I am aware of “ implants  typically do not last a lifetime and may develop complication of implant reconstruction is capsular contracture, in which scar tissue forms around the implant resulting in a firmer, less natural looking breast. In addition to capsular contracture, there are other risks associated with implant-based breast reconstruction  too”.
Any way thanks


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