Wiki excision breast tissue - Pt first wanted breast reconstruction

[diann]

Any help would be appreciated on this one...I think I'm overthinking it!

Complaint: excessive breast tissue, bilateral chest wall mastectomy incisions

Findings: Pt first wanted breast reconstruction after mastectomy but then changed her mind. Consequently, excessive axillary tissue was excised bilaterally.

Description of procedure:
Pt received general anesthesia and both chest walls and axillae were prepped and draped with sterile towels. Pt had excess tissue marked with her sitting up before surgery. Local anethesia was used to anesthetize anticipated incisions. Using a #15 blade knife, the excess tissue was excised in an elliptical fashion. This was carried down through skin, subcutaneous tissue and down the scar. Following removal of the tissue, many layers of 2-0 Vicryl were used to close the incisions primarily. The clips were actually used to close the incisions bilaterally. Dressings were applied. The pat was taken awake to the recovery room in satisfactory condition.

I come up with 19318-50 CPT and 611.89 & V45.89 for diagnosis.

When I called the doctor's office they are using 19260-50 CPT and 757.6 for the diagnosis.

Sooooo....I'm not sure if I am coding this right and am missing (not-understanding) their rational.

Any help would really be appreciated.

Thanks
Diann Do Bran CPC, CPC-H:

 

[surender]

Hi,

As the patient had already undergone mastectomy and now undergoing resection of excessive axillary tissue and not the breast tissue from the mastectomy incisions through elliptical incisions, I feel this should be coded as scar revision and not as mammoplasty or chest wall tumor excision.
The CPT codes should be from series 13131-13133 (depending upon the total size of scars) and the diagnosis should be 709.2.

Would this be of some help?

 

[diann]

Thanks for answering my inquiry. It's nice to know that someone out there looks out for us! I try to help where I can and I like getting feedback on my questions too. I know my inquiry is definitely a confusing one I know.
As I reviewed it, I am more confused now then ever. As I used my 3M encoder I get 15839 for excision of excessive tissue. My path was excision>excessive skin/subcanteous tissue>axilla which gave me the 15839. If I tried breast it gave me 19318 reduction mamaplasty. Since they were excising more than scar tissue, that is why I went this way.....the doctors office "booked" it with 19120 but there is no mention of any new lesions which is why I am hestitant to used that code. (Which is also why I don't understand why they got an authorization and using 19260.) So I don't know......arrrrgh!
But thank you again for giving me an input! I really appreciate it.

 

[bench]

Hi,

If the excision of excess tissue was from the breast, I think you can use the code 19380 (revision of breast reconstruction) with a lay description including excision of excess tissue. but in your case, it seems like the excess tissue was in the axillary area. You may be able to use that code 15839 as excision of excess tissue other area and hopefully you can support that with your diagnosis codes with either "disproportion of reconstructed breast 612.1 or deformity of reconstructed breast 612.0 etc. Also try to look in the pathology report if there is one if there are breast tissues involved in the excision since the tissue excised was kind of deep upto subq and maybe you can use 19380. Hope this gives you an idea.