# Breast Surgery Coding 19301



## Jmeannm (Dec 13, 2012)

Hello all, 

I know this question has been asked repeatedly on this site and I have read the answers and am still confused. I just recently started coding breast surgeries and am giving myself a headache trying to differentiate between when to use 19301 and 19125. My doctor lists the operation performed as: Right breast needle localization oncoplastic partial mastectomy with sentinel lymph node injection and biopsy.

I know that she is not the one doing the initial needle loc, this is done by our radiology team prior to her entering the OR. I am confused on the oncoplastic partial mastectomy. 
In this case I am thinking the code should be 19302, I would like to know your thoughts. I will also be using codes 38500 and 38792 for the sentinel node. Thanks in advance!

This is the op note:

DESCRIPTION OF PROCEDURE:  She is taken to the operating room suite, placed in supine position.  General endotracheal anesthesia is introduced.  Time-out is performed.  All parties agree.  2 cc of dye is injected peritumorly and massaged in for 5 minutes.  Hot spot is marked in the right axilla.  The area is then prepped and draped in normal sterile fashion.  With Dr. xxx(reconstruction doc) starting on the left breast, I (my doc)started on the right axilla, infiltrated with 10 cc of 0.5% Marcaine with epinephrine.  Skin incision was made using a 15 blade.  Subcutaneous tissue was dissected down using Bovie electrocautery and clavipectoral fascia is divided in the same fashion.  One blue-stained node is seen easily at level 1 in the axilla.  Its count was above 4000. This is grasped with an Allis clamp and separated from surrounding tissue using Bovie electrocautery and blunt dissection.  Clips were put on leading lymphatics.  This was removed and the background count remained elevated.  Two additional nodes were found at level 1 in the axilla, one with a count of 407 that was not blue and one with a count of 650 that was not blue that was very small.  These were clipped where appropriate and removed.  Background count was then less than 40.  No additional blue-stained or palpable nodes were found.  Hemostasis was then well obtained and the wound closed using three simple interrupted 3-0 Vicryl sutures.  The skin incisions closed using running subcuticular 4-0 Monocryl.  We then directed our attention to the right breast. 

Dr. xxx (recon) made the incision for a mastopexy and does the de-epithelialization of the skin.  Then I (my doc) used Bovie electrocautery to dissect down into the breast and divide the area around the end of the wire. 

Hemostasis was well obtained.  The specimen is labeled right breast needle localization partial mastectomy, single stitch superior, double stitch lateral.  The wire did fall out on the back table as the specimen was being labeled.  Specimen mammography did not show removal of the clip.  The medial margin was felt to be the one that was left in situ.  It was grasped with Allis clamps and separated from surrounding tissue using Bovie electrocautery.  Of note, this resection involved complete resection down to the clavipectoral fascia.  This was labeled additional medial margin, single stitch superior, double stitch lateral, triple stitch superficial.  Of this, it was felt the superior margin of this area was perhaps a bit close and it was grasped with Allis clamps and reexcised to superior margin, single stitch superior, double stitch lateral.  Hemostasis was well obtained and the clip was found to be in the second specimen.  Clips were put in the resection bed.  All sponge and needle counts correct x2.  The patient tolerated the procedure well.  Dr. xxx (recon) was working at the end of my procedure.


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## BEARDOG (Dec 13, 2012)

you cannot use 19302 as a partial mastectomy with *axillary node dissection *was not done, a partial mastectomy with sentinel node biopsy after injection of blue dye was done. You would need to use :
19301
38500
and 38900

Do not use 38792 as this is now the code for injection of the radioactive isotope, not the blue dye. 38792 would be used by the nuclear med physician that did the injection of the isotope,you would use 38900 which is intraoperative mapping of the sentinel node after injection of blue dye

I hope that is helpful

Debbie, CPC, CGSC


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## BEARDOG (Dec 13, 2012)

Also, if your surgeon was the one who did the specimen mammography you also can use 76098-26 assuming the operating surgeon interpreted the specimen mammo and no report was generated by the radiologist.  Permanent images must have been made to bill for this. 

Debbie, CPC, CGSC


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## sajanamatya (Dec 17, 2012)

The depth (superficial or deep) of level 1 nodes are not documented in OP note. It is better to  ask to doctor to clarify about it? If As level 1 nodes are deep, then, code 38525 must be used.


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