Hello,
Provider performed bilateral mastecomy and also removed some of the pectoral muscle fibers. I am trying to decide if this would be a case where modifier 22 would be added to 19303 or if an unlisted code would be more appropriate?
Op Note
We then moved on to the right breast. Several stab incisions using an 11-blade were then made along the planned incision site. Tumescent solution consisting of 1L LR mixed with 30ml 1%lidocaine and 1 amp of epi (1:1000) was then infused into the superior and inferior flaps via these small incisions using a 14G liposuction catheter. We then made the skin incision using the 10 blade, making sure to include the previously placed incisions. Using the Gorney scissors, we then raised a superior flap to the 2nd rib. Then an inferior flap was created to the infra mammary fold. The dissection was carried out medially to the lateral edge of the sternum and laterally out to the latissimus dorsi. Then the breast was removed in its entirety with some of the pectoral fascia. It was oriented and a stitch was placed at the superior and at the lateral aspect of the breast. Hemostasis was obtained using electrocautery and ligasure. I could feel the tumor at the posterior most aspect of the lower outer quadrant. This did not appear to be involving the pectoral muscle but was very close. As such, I did remove some of the pectoral muscle fibers that were directly behind where the tumor was located.
Path Report
Right breast, nipple-sparing mastectomy:
- Mucinous (colloid) carcinoma, 3.6 cm with associated changes of previous biopsy
site.
- Negative for lymphovascular invasion.
- Focal ductal carcinoma in situ (DCIS), solid and cribriform types without necrosis,
low nuclear grade; DCIS associated with invasive carcinoma and comprising less than 5%
of
entire tumor mass.
- Inked margins of resection negative for in-situ and invasive carcinoma, in-situ and
invasive carcinoma focally within less than 0.5 mm of inked posterior margin, 1.6 cm
from
inferior-anterior margin, 2.0 cm from nipple margin, and 4.2 cm from superior-anterior
margin.
- Scant skeletal muscle present, not involved by mucinous carcinoma.
Provider performed bilateral mastecomy and also removed some of the pectoral muscle fibers. I am trying to decide if this would be a case where modifier 22 would be added to 19303 or if an unlisted code would be more appropriate?
Op Note
We then moved on to the right breast. Several stab incisions using an 11-blade were then made along the planned incision site. Tumescent solution consisting of 1L LR mixed with 30ml 1%lidocaine and 1 amp of epi (1:1000) was then infused into the superior and inferior flaps via these small incisions using a 14G liposuction catheter. We then made the skin incision using the 10 blade, making sure to include the previously placed incisions. Using the Gorney scissors, we then raised a superior flap to the 2nd rib. Then an inferior flap was created to the infra mammary fold. The dissection was carried out medially to the lateral edge of the sternum and laterally out to the latissimus dorsi. Then the breast was removed in its entirety with some of the pectoral fascia. It was oriented and a stitch was placed at the superior and at the lateral aspect of the breast. Hemostasis was obtained using electrocautery and ligasure. I could feel the tumor at the posterior most aspect of the lower outer quadrant. This did not appear to be involving the pectoral muscle but was very close. As such, I did remove some of the pectoral muscle fibers that were directly behind where the tumor was located.
Path Report
Right breast, nipple-sparing mastectomy:
- Mucinous (colloid) carcinoma, 3.6 cm with associated changes of previous biopsy
site.
- Negative for lymphovascular invasion.
- Focal ductal carcinoma in situ (DCIS), solid and cribriform types without necrosis,
low nuclear grade; DCIS associated with invasive carcinoma and comprising less than 5%
of
entire tumor mass.
- Inked margins of resection negative for in-situ and invasive carcinoma, in-situ and
invasive carcinoma focally within less than 0.5 mm of inked posterior margin, 1.6 cm
from
inferior-anterior margin, 2.0 cm from nipple margin, and 4.2 cm from superior-anterior
margin.
- Scant skeletal muscle present, not involved by mucinous carcinoma.