Outpatient Facility Coding Alert

Question: The provider performs lumpectomy to remove a suspicious lump in the patient’s right breast. How do we code for this?

Maine Subscriber

Answer: You may use the code 19301 (Mastectomy, partial [eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy) because this procedure is a partial mastectomy, where the provider works to remove cancerous (or suspected to be cancerous) tissue or a lump in the breast using an open incision. The CPT® code 19301 covers lumpectomy, tylectomy, quadrantectomy, or a segmentectomy.

In a quadrantectomy, a quarter of the breast is removed by mastectomy. In lumpectomy, theentire lump of the breast along with the margin of tissue which surrounds the breast is removed. In tylectomy only the tumor and surrounding margin is removed and, in some cases, lymph nodes under the arm are also removed.

If the provider had removed the axillary lymph nodes as well, you would report 19302 (Mastectomy, partial [eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy]; with axillary lymphadenectomy).

Beware “staged” exception: Following some partial mastectomies (19301), during the postoperative period the surgeon may inspect to rule out any lymph node involvement and, if he finds that to be the case, he may opt to remove the nodes as well. Here, you may report the lymphadenectomy as a staged procedure, with 38745 and modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period).

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