# Breast Procedure- Would i code as flap or mass removal?



## KBean2018 (Apr 25, 2019)

Would I use 19120 or 14000? thanks so much!
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Pre-op Diagnosis: Breast mass in female [N63.0]

Post-op Diagnosis: SAME
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CPT Code: Procedure:    DIAGNOSTIC EXCISION LEFT BREAST MASS 
*PR EXCISE BREAST CYST
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ICD-10 : Post-Op Diagnosis Codes:
   * Breast mass in female [N63.0]
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Specimens: 
ID	Type	Source	Tests	Collected by	Time
A : palpable mass left breast	Breast	Breast, Left	SURGICAL PATHOLOGY TISSUE EXAM	
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Findings: dense inframammary ridge bilaterally, more pronounced left lower inner parasternal breast margin with ill-defined mass effect.  A curved incision was made more centrally with a thick flap created to the area of interest which is generously excised using Harmonic Focus to avoid cautery with her pacemaker in place.  At conclusion there is a deliberate flattening of the area without marked contour loss and incision is closed in layers. I did not place a clip.


Indications: She has a prominent inframammary ridge, more so on the left with a slight swelling in the left lower inner quadrant adjacent to the sternum.  Imaging discloses no pathology.  I performed a needle biopsy and that was nondescript tissue and I would have expected fat necrosis.  As an alternative to continued monitoring, she and I decided to pursue a diagnostic excision both to remove the mass but also to assure absence of a proliferative disorder.
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Description of Procedure: In the supine position with appropriate monitoring she received general anesthesia with IV antibiotic.  The left breast is prepped with chlorhexidine and draped after 3 minutes.  A curved incision is made about 3 fingerbreadths from the lower inner quadrant breast margin, scalpel enters the subcutaneous adipose tissue and I now used Harmonic Focus with a thick 6 mm flap dissected to the medial most margin, and then circumferentially until amputated.  I take a small volume more inferiorly to result in a smooth transition and deliberate flattening (the mound has been removed).  I used 4-0 Vicryl suture and create a lateral subcutaneous flap and attached superficial aspect of this carried medially to the underside of the medialmost flap.  A few more simple interrupted subcutaneous sutures were placed and then the skin closed with subcuticular technique.  A Steri-Strip was used as a dressing, she tolerated a Steri-Strip before but otherwise is intolerant of other adhesives.  She is now awakened and extubated, transported to PACU.
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## meghanhannus (Apr 25, 2019)

Hello KBean2018,

I would not code as a flap CPT 14000. I am thinking either CPT 19120 _(RT/LT)_ or CPT 19301_(RT/LT)_  since documentation mentions breast margins along with mass.

CPT 19301: The physician excises the mass along with a margin or rim of healthy tissue. This procedure is often referred to as a segmental mastectomy or a quadrantectomy, but is also called a lumpectomy. The incision is repaired with layered closure and a dressing is applied.

What do you think? Maybe check path report to see if additional margin was taken?


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## abbastro (Jun 26, 2019)

Hi KBean2018,

Based on CPT assistant, October 2017 page 9, " it is not appropriate to report either code _14000, Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less_, or _14001, Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm_, in addition to code _19301, Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)_, because simple, intermediate, and complex layered closure is included in the work represented by code 19301."

I would agree that this is a lumpectomy per CPT assistant April 2005 pages 6 and 7 "Partial mastectomy procedures (eg, lumpectomy, tylectomy, quadrantectomy, or segmentectomy) describe open excisions of breast tissue and include specific attention to adequate surgical margins surrounding the breast mass or lesion."

Hope this helps!


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