# Excision of dilated ducts?



## BFAITHFUL

What cpt code(s) can I use for the following? CPT 19120? thanks



This is a 79 year old female with a nipple discharge from the right breast 4 o'clock position. Ultrasound finding of dilated duct in the areolar position of this breast. She comes in for exploration of nipple areolar complex and excision of dilated ducts, right breast.

DESCRIPTION OF PROCEDURE:
The patient was given IV antibiotics. She was placed on table in supine position with IV sedation given. A folded sheet is beneath the right chest, right arm and breast was prepared with Betadine draped out sterilely. Ultrasound was draped out sterilely. Using ultrasound, we located the area of dilated ducts and profound periareolar incision both with sterile marking pen. We attempted to cannulate the 4 o'clock duct, from which was seen some clear fluid with a Prolene suture, but unable to cannulate it well. Despite this, we are able to mark out the approximate area of the dilated ducts with a sterile marking pen. Infiltration of 1% lidocaine was now made in the skin and depended surgical site and deeply we placed Marcaine around the area of the intended surgery.


We make a periareolar incision developed through skin and subcutaneous tissue and then developed a subareolar dissection to the nipple areolar complex, where we excised ductal tissue and brought that directly down to the underlying pectoralis fascia and then peeled that breast tissue in a wedge shaped fashion away from the areolar nipple complex and excised it to a point that is just lateral to our incision and removed the breast tissue from a lateral to medial fashion or from the nipple areolar complex to a medial breast fashion at 4 o'clock. The specimen was removed. Subareolar components were labeled with a silk; its superior border was labeled with a short Vicryl. The wound was irrigated and dried. No bleeding was present. We invert the nipple areolar complex into the wound to make sure we see no other evidence of drainage or dilated ducts. We now make sure any oozing was stopped with cautery. The wound was closed in layers with interrupted inverted 3 0 Vicryl and then the skin x2 layers and then the skin closed with running 4 0 Monocryl. Now benzoin Steri Strips were placed followed by Telfa Bio occlusive. The patient tolerated the procedure well and went to recovery room in stable condition. Instrument, lap count, needle count, and sponge count were all correct at the end of procedure.


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## BFAITHFUL

any takers on this one?


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## johnmeyer

I would think you could. Granted, I didn't see anything about an excision of a cyst, fibroadenoma, or other tumor, but.... the duct was excised and 19120 is the closesting thing I can see.


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## Lisablawusch

I found 19110.  Hope this helps


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