I'm stuck on a mastectomy and not sure what all I should bill for. Here's the OP note:
...The left chest and axilla were prepped. 2cc of methylene blue dye were injected in the retroareolar dermis and the breast was massaged. An elliptical incision was marked and incised. Flaps were elevated superiorly to the infraclavicular border medially to the edg eof the sernum and inferiorly to the inframammary creast laterally to the surface of the axilla. From this point the axilla was entered. Neoprobe was used to guide dissection efforts and sentinel node, which was firm to palpation and without blue dye staining, was harvested and sent to path. This was returned on the frozen section as invasive cancer and therefore plans were made for an axillary dissection in light of those result. The breast was elevated now from the surface of the pectoral muscle, taking the pectoral fascia as well. The breast was separated from the attachments to the axillary fossa, marked with a short stitch superiorly and a long stitch laterally and submitted to path. Axially dissection was begun following the pectoral muscle up to identify the axially vein. The axially contents were cleared off from the chest wall, identify and preserving the long thoracic nerve. The axillary contents were swept inferiorly from the axillary vein leaving the nodal tissue superior to the axillary vein in place. The thoracodorsal nerve, artery and vein were identified and preserved as the remainder of the axillary contents were swept inferiorly off the subscapularis and latissimus. The remaining attachments were divided...
Do I use 19302 or 19303 with 38792, 38525? Or does the biopsy not get coded since he did the full procedure? Thoughts? Codes?
...The left chest and axilla were prepped. 2cc of methylene blue dye were injected in the retroareolar dermis and the breast was massaged. An elliptical incision was marked and incised. Flaps were elevated superiorly to the infraclavicular border medially to the edg eof the sernum and inferiorly to the inframammary creast laterally to the surface of the axilla. From this point the axilla was entered. Neoprobe was used to guide dissection efforts and sentinel node, which was firm to palpation and without blue dye staining, was harvested and sent to path. This was returned on the frozen section as invasive cancer and therefore plans were made for an axillary dissection in light of those result. The breast was elevated now from the surface of the pectoral muscle, taking the pectoral fascia as well. The breast was separated from the attachments to the axillary fossa, marked with a short stitch superiorly and a long stitch laterally and submitted to path. Axially dissection was begun following the pectoral muscle up to identify the axially vein. The axially contents were cleared off from the chest wall, identify and preserving the long thoracic nerve. The axillary contents were swept inferiorly from the axillary vein leaving the nodal tissue superior to the axillary vein in place. The thoracodorsal nerve, artery and vein were identified and preserved as the remainder of the axillary contents were swept inferiorly off the subscapularis and latissimus. The remaining attachments were divided...
Do I use 19302 or 19303 with 38792, 38525? Or does the biopsy not get coded since he did the full procedure? Thoughts? Codes?