General Surgery Coding Alert

Surgeon intent still matters most for excisions CPT 2007 creates a whole new subsection dedicated to mastectomy procedures and stocks it with eight new codes (19300-19307). A close look reveals, however, that the changes are far from groundbreaking: The descriptors for 19300-19307 match exactly the descriptors for the familiar (and now outdated) breast excision procedures 19140-19240.

The good news: You won't have to struggle to learn new guidelines when reporting mastectomy procedures, and the new mastectomy codes are more clearly grouped than in the past.

The bad news: CPT 2007 doesn't offer additional clarification on how to differentiate a breast lesion excision from, for example, a partial mastectomy. Meet the New Codes - Same as the Old Codes You will find the mastectomy codes following the breast incision (19000-19030), excision (19100-19272) and introduction (19290-19298) subsections. Although the five-digit codes are new, CPT took the descriptors from the now-deleted excision codes 19140-19240, as outlined below: 2007 Code     Deleted             Code Descriptor 19300            (19140)                Mastectomy for gynecomastia

19301            (19160)                Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy)

19302            (19162)                ... with axillary lymphadenectomy

19303            (19180)                Mastectomy, simple, complete

19304            (19182)                Mastectomy, subcutaneous

19305            (19200)                Mastectomy, radical, including pectoral muscles,  axillary lymph nodes

19306            (19220)                Mastectomy, radical, including pectoral muscles,axillary and internal mammary lymph notes (Urban type operation)

19307            (19240)                Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding  major muscle

The intent of the changes seems to be to separate the mastectomy procedures from less-extensive excisions as described by 19100-19272.

-By creating a new subsection and renumbering the codes, the CPT manual becomes better organized and the mastectomy codes easier to find,- says M. Trayser Dunaway, MD, FACS, CSP, CHCO, CHCC, a surgeon, physician and coding educator, and healthcare consultant in Camden, S.C.  Margins Matters for Excision vs. Mastectomy As in the past, however, you can't look to CPT to give you instructions on when a -mere- breast excision (19120, Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion [except 19300], open, male or female, one or more lesions) crosses the line and becomes a partial mastectomy (19301). Instead, you must consider the surgeon's intent when performing the excision and, specifically, whether the surgeon allows for adequate margins around the excised tissue.

In general: If the surgeon removes a breast lesion along with a margin of healthy tissue, you can choose the partial mastectomy code (19301) to describe the procedure, says Donald Keenan, MD, PhD, assistant professor of surgery at the University of Pittsburgh School of Medicine and attending breast surgeon for the Magee-UPCI Breast Program.

There is no specific requirement in CPT that says the margin must be of a specific size to qualify as a partial mastectomy. Rather, the margins must only be -adequate- to ensure that the surgeon removes possible malignant tissue surrounding the [...]