# breast mastectomy question-Can anyone guide



## BABS37 (Sep 13, 2012)

Can anyone guide me in the direction of the right code? I feel like it's missing documentation. My vote was 19303-RT, 38500, 38900

Procedure:
1. Right simple mastectomy
2. Right axillary sentinel lymph node biopsy
3. Injection of blue dye for sentinel node identification
4. intermediate closure 12 cm length

...2cc of methylene blue were injected into the retroareolar dermis and the breast was massaged for five minutes. An elliptical incision was made encompassing the nipple-areolar complex. The flaps were elevated superiorly to the clavicle, medially to the boarder of the sternum, and inferiorly to the infamammary crease, laterally to the surface of the axillary space was exposed, a needle probe was used to guide dissection efforts and blue stained hot sentinel node was excised. The ex-vivo 10-second count was 25000. Backround count was 685, so the sentinel node dissection was complete. This was sent to path. The remainder of the pectoral fascial attachments were amputated. A 10 flat JP drain was placed over the pectoral fascia and then an intermediate closure was performed 12cm in length...After completion of the mastectomy and examination of the specimen, some puckering of the pectoral fascia was visible beneath the tumor. Because of the concern of possible positive margin there, a portion of the pectoral muscle was excised for re-excision of the deep margin and this was labeled as such and submitted to path.


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## syllingk (Sep 13, 2012)

19303-rt, 38525-51, 38900.


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## BABS37 (Sep 14, 2012)

Thank you for the response! Can you tell me what I'm looking for when using 38500 or 38525? If it said a couple of sentinel nodes were dissected- that would mean 38500 but if it says " so the sentinel node dissection was complete" that means he removed all nodes so that would qualify for 38525? Sorry, I'm just trying to make sure I get these right in the future.


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## syllingk (Sep 14, 2012)

My surgeons told me that most sentinel nodes are deep and to use 38525. The code doesn't state how many nodes are removed/biopsied, just wether it was superficial or deep. 
Your note states surgeon found one node and removed it and the axilla now had all low counts so node disection was complete. That doesn't mean he took out all the nodes. Just the hot ones. 
And of course any re-excision of margins at the same operative session is included.


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## BABS37 (Sep 14, 2012)

I can handle that. I had 38525 explained to me like this in red on a mastectomy question a few months back that's why I asked lol! I'm just trying to get a clear picture. Thanks for your help. I think I finally have it figured out!! Phew 

 19303 is for the mastectomy only and 38525 is for some but not all of the lymph nodes only.

Think of it this way.... 38525 is used when say, 1 - 5 nodes are excised but in this report it appears that all of the axillary lymph nodes were excised so we wouldn't use it here.


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