Wiki Mastectomy Coding

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MelBarclay

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Our dr mainly performs Lumpectomy/Partial Mastectomy using code 19301. However; we have a recent case that our dr reported the mass was very large and had a confirmed invasive ductal cancer diagnosis so the patient did not want breast conservation therapy. He stated that he removed a deep axillary node after using methylene blue injection to identify the node. He then made an incision around the nipple areolar complex to incorporate the incision in the axilla. Dissection carried down to the pectoralis muscle and the fascia was removed.

I was going to code using 19303, 38525 and 38900 using appropriate modifiers as well. Our facility coders think this should be coded as a 19301, 38500. Any suggestions...I just want to make sure I'm not under coding as this seems much more difficult than our typical breast cases.
 
MelBarclay said:
Our dr mainly performs Lumpectomy/Partial Mastectomy using code 19301. However; we have a recent case that our dr reported the mass was very large and had a confirmed invasive ductal cancer diagnosis so the patient did not want breast conservation therapy. He stated that he removed a deep axillary node after using methylene blue injection to identify the node. He then made an incision around the nipple areolar complex to incorporate the incision in the axilla. Dissection carried down to the pectoralis muscle and the fascia was removed.

I was going to code using 19303, 38525 and 38900 using appropriate modifiers as well. Our facility coders think this should be coded as a 19301, 38500. Any suggestions...I just want to make sure I'm not under coding as this seems much more difficult than our typical breast cases.
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19303, 38525 ( report 38525 Surgeon needs to indicate in op report that open deep axilla node (sentienal node) remove, or it is indicated in path report " level 2+" to assign this code. Otherwise , just assign 38500), and 38792 (CPT 38900 which is for "mapping" the sentinel nodes (where they trace blue dye or heat from a radioactive tracer to locate and then remove the sentinel nodes). The blue dye was injected before surgery but doesn't clearly document following that blue dye to locate his sentinel nodes to qualify for mapping, then code 38792)
 
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