Wiki lumpectomy

[tsaunders10]

Good Morning,
I am looking for advise on how to code this procedure. I am attaching the op report for the patients lumpectomy. Any help will be appreciated.
Thank you

 

[fwnewbie]

Start by finding your diagnosis code in ICD using the post-op diagnosis from the note. Then, look in the CPT index under "excision" for breast tissue and axillary nodes. Since this is probably a Medicare pt (age 75), use HCPCS for the drugs. And if you are billing for the facility, you have to also code the radiology/pathology resources used. Happy Hunting!

 

[tsaunders10]

Thank you I am billing for the Surgeon. The surgeon has codes 19301, 38525,38792,59,38900,76000. I do not feel this is correct.

 

[fwnewbie]

What code/s do you think are wrong and what would you replace with? I'm not sure why s/he want to code radiology because unless s/he did it themselves, the facility would be billing that. I think the facility would also code the lab work, the needle localization, and the meds used.

 

[csperoni]

DISCLAIMER: I do not typically code breast surgery
It looks to me like 19301 and 38525 should be billed instead as 19302 (mastectomy, partial with axillary lymphadenectomy) to avoid unbundling.
38792 (injection radioactive tracer) and 38900 (mapping sentinel lymph nodes) seem correct. Please note I would add -LT modifiers to both of those. Also, 38792 is a column 2 CCI edit for 38900, so would require -59 to not bundle.
76000 (fluoroscopy (separate proc) up to 1 hour) does not seem correct. I do not see where in the op note fluoro was done, but I could be missing it. If you see where this was done, then add -26 modifier since the physician does not own the hospital radiology equipment.