Wiki Billing of excision of nipple areolar complex and the surrounding tissues

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kathleeng

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Hi, I have a question on what CPT code would be most appropriate for a surgery of the excision of the nipple areolar complex and the surrounding inflamed tissues for a chronic breast infection. The area excised was 12 cm and included the nipple, underlying breast tissue and any fistula tracts that had been seeding into the breast tissue. I was looking at 19120 since it can include a small portion of surrounding tissue, however due to the size of 12cm, I was also looking at 19301, but did not notice any mention of the margins. I'm also looking at the possibility of billing both 19120 and 19112 (excision of the fistula ducts), however they do have an edit between the codes and only one incision was made, so I don't believe that would justify the modifier 59. Any suggestions or feedback would be greatly appreciated! Thank you.
 
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nickelclaw said:
can you attach OP note?
Click to expand...
Yes, sure. Here is an excerpt of it "...A large elliptical incision was made incorporating the inflamed tissue and the nipple areolar complex. The skin was significantly injected with multiple collateral blood flow. I took the underlying breast tissue for approximately 2 cm to remove any fistulous tracts that had been seeding into the breast tissue. This entire area measured 3 x 12 cm. Once this inflamed tissue was removed. The wound was copiously irrigated. Clean gloves were used to close the wound. This was done in multiple layers..."
 
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Since duct wasn't mentioned I am not liking the 19112 as this would be for excision of lactiferous duct fistula
If was for biopsy 19120 (cyst) on path or benign lesion
I am leaning toward the 19301:)
There is the possibility of 19110 nipple exploration with or with excision of duct but again it wasn't mentioned
 
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nickelclaw said:
Since duct wasn't mentioned I am not liking the 19112 as this would be for excision of lactiferous duct fistula
If was for biopsy 19120 (cyst) on path or benign lesion
I am leaning toward the 19301:)
There is the possibility of 19110 nipple exploration with or with excision of duct but again it wasn't mentioned
Click to expand...
Great, thank you so much for your feedback. It's greatly appreciated!!
 
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