Joyce Burchett
Networker
I would appreciate anyone's help with coding this procedure. Not sure if CPT 19120 & 49185 would be the way to go with this procedure. Pt. has had a right total mastectomy & is not in a post-op period. She has developed a chronic seroma in the right mastectomy flap w/multiple drainage procedures. She has had oral antibiotics & outpatient sclerotherapy of the seroma cavity without success. She was offered a surgical excision of the seroma capsule as well as sclerotherapy & agreed to proceed. She was marked in the holding area & brought to the OR. After induction of general anesthesia chest was prepped & draped. I marked the excess skin of the mastectomy incision to include the actual scar as well as excess skin longitudinally & this excess skin expected to be removed measured approximately 35 cm X 6 cm. I made my skin incision along the markings. I deepened my incision through the subcutaneous fat using electrocautery. I then elevated the dermal flap superiorly & inferiorly to excise the seroma capsule along with the excess skin excision. The seroma cavity extended superomedially in the infraclavicular region. The excision was quite difficult, given the densely adherent nature of the seroma capsule to the underlying pec muscle. Once this specimen was removed it measured 28 cm long x 14.5 cm tall x 5 cm deep. Orientation stitches were placed on the specimen to mark the margins & specimen submitted to pathology. I irrigated the mastectomy wound with 3 L of saline mixed w/betadine solution until entire bag was emptied. Hemostasis was achieved. I placed a #15 round Blake drain into the wound & externalized it the the midclavicular line. Drain secured to underlying skin. Next, I tacked the superior mastectomy flap to the pec muscle by using quilting techinque with 2-0 PDS. The superior & inferior mastectomy flaps we approximated deeply with 2-0 vicryl, then deep dermis was closed with running Quill & skin was closed. A 500 ml of doxycycline mixed with 25 ml saline flushed into the drain to use as a chemical sclerosant. The drain was clamped & the incision dressed. Then a Prevena incisional VAC system was placed on top of the incision. An occlusive dressing was placed around the drain site & a compressive breast wrap was placed around the patient's chest.