Wiki Help with Re-excision of margins for breast cancer

[Coastal Coder]

I may be over thinking this due to it being late in the day, so I thought I would ask for help

I have a patient in office procedure Margin Re-excision as follows.....

Indication: The patient has a recurrent breast cancer of the skin and subcutaneous tissue of the left breast which wider excision is recommended.

After obtaining informed consent, the skin of the left breast at the 9 o'clock aspect was prepped with Betadine. I then infiltrated 10 cc's of lidocaine.
I made a 4.0 cm X 2.0 cm elliptical incision around her previous biopsy site and went deep down into the fatty tissue. The lesion was removed. The margins are labeled. The wound was closed in 3 layers.
The deep layer with 3.0 vicryl, the intermediate layer with 3.0 vicryl and the skin with 4.0 monocryl in a running subcuticular fashion.

Should I code this as 19120 due to the depth, or 11606, 12032 or something completely different?

HELP,

Thanks,

Michelle

 

[kalpana]

To report re-excision 11606 with modifier 58 if within 10 global days and intermediate or complex closure!

 

[liloe517]

I would see this as a 19301 -58 because the Dr removed a mass with margins.

 

[thomas7331]

I would query the provider on this as it is not really clear from this note whether this is a skin cancer located on the breast, or an actual breast cancer. Additionally, if this is a skin cancer lesion, you would need to know the dimensions of the lesion plus margins in order to select the correct code for the excision - the dimensions of the incision can't be used to code the size of the lesion. Since this is a re-excision, you should have a previous excision note and pathology report available to guide you on this though.