# Chest wall resection



## penswhitex (Aug 1, 2014)

Hi.  Hope everyone is having a wonderful day.  I need help on what code to use for this procedure.  

Procedure:  Left chest wall resection with pectoralis major muscle requiring cutaneous flap closure.

Operative report:  The previously marked resection site on the left chest was identified and elliptical excision of the prior resection site was performed with a 2 cm margin.  The dissection was carried down to the pectoralis major muscle and the medial portion of the muscle was excised down to the chest wall rib and intercostal muscle layer and it was left intact on the specimen.  A suture was placed laterally for orientation.  Cutaneous flaps were then raised dissecting the subcutaneous off of the fascia cephalad and caudad for several centimeters in order to allow primary closure of the skin without undue tension.  A 10-mm Jackson-Pratt drain was placed and brought out inferolaterally through a separate stab wound and sewn in place with silk. The flaps were then closed with interrupted 2-0 Vicryl followed by staples for skin.

I've ruled out 19260 because the ribs were left intact.  My only other option that i can come up with is 21558.  Any input would be greatly appreciated.

Thanks.


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