kmason1429
New
We did not get pre-certification from Cigna for a breast reconstruction (history of cancer.)
Initially, coded claim as:
19328-RT
19316-58-LT
19342-58-RT
19370-58
Dx: V10.3
I am wondering if we can correct the coding to:
19366-50
11970-58
19120-59
Dx: V10.3 & 709.8
Path results:
A. Skin, right breast (granuloma tissue):
- Ulcerated, inflamed granulation tissue with repair (707.8/709.2)
- Adjacent fibrinous exudate
B. Skin, left breast:
- Skin and subcutis with focal necrosis and degeneration (709.8)
Op Note:
Left breast was dissected. A 42mm circular template was placed around the nipple areolar complex and inscribed with a scalpel. The area between NAC and the proposed incision lines was de-epithelialized with the scalpel. Skin flaps were elevated to the chest wall with sharp dissection techniques leaving the breast mound attached centrally. 3-0 horizontal mattress suspension sutures from the parenchyma to muscle were used to suspend the gland in the superior medial direction. In addition the inferior gland was plicated for additional support. The closure was done in layers with 3-0 polydiaxone sutures. The nipple areolar complex was inset in layers as well.
Now attention was directed to the right side. The previous mastectomy incision was used to gain access to the lateral portion of the pectoralis muscle. A muscle splitting technique was used to expose the capsule. The capsule was opened with electrocautery and the pocket was explored. There was a seroma with some granulation tissue, but there was no evidence of free fluid, infection, or abnormally thickened capsule. Cultures and biopsies of the capsule were sent. The lighted retractor and electrocautery was used to explore the pocket. The pocket was irrigated with copious amounts of triple antibiotic saline, then betadine, and then saline again. Sterile sizers were placed and it was determined that the 450 cc size was most appropriate to achieve symmetry. In addition, it was determined that to achieve symmetry, a lateral capsulorrhaphy and medial capsulotomy were required. Tis was completed with interrupted 0 prolene horizontal mattress sutures on the lateral capsule. Again, copious amounts of irrigation were used. A 10 French closed suction round drain was placed. The implant was placed in the submuscular. The wound was closed in multiple layers including; pectoralis fascia, Scarpa's fascia, the deep dermis, and an intracuticular 3-0 polydiaxone running suture.
Thanks for any and all help on CPT and DX.
Initially, coded claim as:
19328-RT
19316-58-LT
19342-58-RT
19370-58
Dx: V10.3
I am wondering if we can correct the coding to:
19366-50
11970-58
19120-59
Dx: V10.3 & 709.8
Path results:
A. Skin, right breast (granuloma tissue):
- Ulcerated, inflamed granulation tissue with repair (707.8/709.2)
- Adjacent fibrinous exudate
B. Skin, left breast:
- Skin and subcutis with focal necrosis and degeneration (709.8)
Op Note:
Left breast was dissected. A 42mm circular template was placed around the nipple areolar complex and inscribed with a scalpel. The area between NAC and the proposed incision lines was de-epithelialized with the scalpel. Skin flaps were elevated to the chest wall with sharp dissection techniques leaving the breast mound attached centrally. 3-0 horizontal mattress suspension sutures from the parenchyma to muscle were used to suspend the gland in the superior medial direction. In addition the inferior gland was plicated for additional support. The closure was done in layers with 3-0 polydiaxone sutures. The nipple areolar complex was inset in layers as well.
Now attention was directed to the right side. The previous mastectomy incision was used to gain access to the lateral portion of the pectoralis muscle. A muscle splitting technique was used to expose the capsule. The capsule was opened with electrocautery and the pocket was explored. There was a seroma with some granulation tissue, but there was no evidence of free fluid, infection, or abnormally thickened capsule. Cultures and biopsies of the capsule were sent. The lighted retractor and electrocautery was used to explore the pocket. The pocket was irrigated with copious amounts of triple antibiotic saline, then betadine, and then saline again. Sterile sizers were placed and it was determined that the 450 cc size was most appropriate to achieve symmetry. In addition, it was determined that to achieve symmetry, a lateral capsulorrhaphy and medial capsulotomy were required. Tis was completed with interrupted 0 prolene horizontal mattress sutures on the lateral capsule. Again, copious amounts of irrigation were used. A 10 French closed suction round drain was placed. The implant was placed in the submuscular. The wound was closed in multiple layers including; pectoralis fascia, Scarpa's fascia, the deep dermis, and an intracuticular 3-0 polydiaxone running suture.
Thanks for any and all help on CPT and DX.
