General Surgery Coding Alert

Question: Our surgeon performs a partial mastectomy and if the deformity is too big then he performs a oncoplastic reconstruction of the breast with the 3D Biozorb implant and pedicled flap 40 sq cm. How should we code this?

Codify Subscriber

Answer: The correct codes are 19301 (Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)), 19340 (Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction), and 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm).

Caution: For the adjacent tissue transfer, make sure that the surgeon describes the size of the primary and secondary defect, because you should add the defect sizes when selecting the code for that service. Failing to count the secondary defect could potentially result in selecting the wrong code and sacrificing pay.

For instance: If the primary defect was 40 sq cm and the secondary defect to create the flap was 30 sq cm, the total size for coding would be 70 sq sm. In that case, you would report 14301 plus +14302 (Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure)). Failing to add the secondary defect would cost you $227.73 in missed revenue (Medicare Physician Fee Schedule national non-facility amount, conversion factor 36.0896).