# Breast Cancer in chest wall and axilla



## crhunt78 (Feb 17, 2010)

One of our surgeons operated on a pt who was diagnosed with breast cancer.  Her original mastectomy was performed in December and she presented again in January with metastasis to the chest wall that involved the pectoralis and pectoralis muscle and the axilla.  The physician then performed an axillary dissection (which I know how to code) but then he had to re-excise the entire mastectomy incision and surrounding skin.  He basically completely removed the chest wall tumor and skin recurrence from the pt's chest wall.  Does anyone have any idea how I might code this?  I'm not sure I explained it very well.  The only code we came up with was the unlisted breast code (19499) but I thought we might be able to use a skin excision code from the 11600 series.  The excision was big enough that the closure was done by a plastic surgeon.  Any help would be appreciated!  Thank you in advance!


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## FTessaBartels (Feb 17, 2010)

*19271?*

You do not mention involvement of ribs ... but have you looked at 19271 or 19272?

Both these codes include the plastic reconstruction, so both surgeons would use the same code with a -62 modifier.

Otherwise I'm thinking you may need to use the radical mastectomy codes. 

Don't forget your -78 modifier, too.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## crhunt78 (Feb 18, 2010)

There was no rib involvement, only the skin on the mastectomy area and the underlying chest wall and axilla.  The plastic surgeon only did the closure, nothing else.  I'm thinking we may have to use a code from the 11600 series....malignant skin?


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