General Surgery Coding Alert

Question: A patient had mammographic-directed needle localization of the tumor. The surgeon made an elliptical skin incision directly over the tumor and used electrocautery to divide the subcutaneous fatty tissue and to dissect through breast tissue. The surgeon continued dissection with the electrocautery until the mass, including the localization wires, were removed and included with the specimen as well. The pathology states "lumpectomy, left breast with needle localization, measuring 11 x 8 x 4 cm. Benign dystrophic calcification." Should I code this procedure with 19301-LT or 19125-LT?

Louisiana Subscriber

Answer: You should use 19301 (Mastectomy,partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy]). You do not need modifier LT (Left side), however, unless your surgeon was also performing another procedure on the right side and you need to distinguish which procedure was done on which side.

From the procedure's description , it doesn't seem like your provider participated in the localization process, so the fact that the needles were placed doesn't change the coding.

Why not 19125: Code 19125 (Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion) is, essentially, for a biopsy. There is no expectation that there will be attention to surgical margins.

If the surgeon actually performed a lumpectomy,the expectation is that he paid attention to surgical margins (which is, of course, difficult when the lesion is neither palpable or visually identifiable).

Caveat: If you think that this was really a biopsy rather than a true lumpectomy, you should go back to the physician and get further clarification.