D.R.
Networker
Would appreciate everyone's opinion please. I see multiple ways of coding this. Just not sure which is correct. Provider wants to submit complex closure only. What are the opinions on 19120, or excision B9 lesion codes 11400-11406 (depending on area size excised which is not documented) in addition to complex closure codes or 15839 which will probably deny as cosmetic. TIA
INDICATION FOR PROCEDURE:
62 year-old female with history of right Poland syndrome and right breast construction with implant 46 years ago who had previous left reduction for symmetry, however the left breast is larger than right breast with excess skin and subcutaneous tissue to inferior lateral aspect of breast. Patient was recommended for left breast scar revision for improved symmetry. All risk and benefits were discussed with the patient, who agreed to proceed and an informed consent was obtained. A final timeout was performed, confirming the correct patient and procedure; all parties were in agreement.
Attention was turned to the left breast. In order to address the excess breast tissue compared to the contralateral reconstructed breast, including the axillary tail extending laterally into the axilla, the decision was made to do a wedge excision of the excess breast tissue laterally. An ellipse was designed extending from the prior IMF incision laterally into the axilla. Incision was made with a #15 scalpel and carried down to the skin to the subcutaneous tissue. Bovie electrocautery was used to dissect out a wedge of underlying breast tissue and subcutaneous tissue, which was noted to significantly improve the contour and symmetry. The tissue was passed off and sent for pathology. The wound was irrigated with normal saline, and hemostasis was ensured with Bovie electrocautery. After obtaining satisfactory hemostasis, the wound was closed in layered fashion using buried deep dermal 3-0 Vicryl, followed by running subcuticular 4-0 Monocryl. Total repair measured 22 cm in length. Surgical site was locally infiltrated with 20 cc of 50/50 mix of 1% lidocaine with epinephrine and 0.5% Marcaine plain. The incision was dressed with bacitracin, Xeroform, dry gauze, ABD, and tape.
INDICATION FOR PROCEDURE:
62 year-old female with history of right Poland syndrome and right breast construction with implant 46 years ago who had previous left reduction for symmetry, however the left breast is larger than right breast with excess skin and subcutaneous tissue to inferior lateral aspect of breast. Patient was recommended for left breast scar revision for improved symmetry. All risk and benefits were discussed with the patient, who agreed to proceed and an informed consent was obtained. A final timeout was performed, confirming the correct patient and procedure; all parties were in agreement.
Attention was turned to the left breast. In order to address the excess breast tissue compared to the contralateral reconstructed breast, including the axillary tail extending laterally into the axilla, the decision was made to do a wedge excision of the excess breast tissue laterally. An ellipse was designed extending from the prior IMF incision laterally into the axilla. Incision was made with a #15 scalpel and carried down to the skin to the subcutaneous tissue. Bovie electrocautery was used to dissect out a wedge of underlying breast tissue and subcutaneous tissue, which was noted to significantly improve the contour and symmetry. The tissue was passed off and sent for pathology. The wound was irrigated with normal saline, and hemostasis was ensured with Bovie electrocautery. After obtaining satisfactory hemostasis, the wound was closed in layered fashion using buried deep dermal 3-0 Vicryl, followed by running subcuticular 4-0 Monocryl. Total repair measured 22 cm in length. Surgical site was locally infiltrated with 20 cc of 50/50 mix of 1% lidocaine with epinephrine and 0.5% Marcaine plain. The incision was dressed with bacitracin, Xeroform, dry gauze, ABD, and tape.