janet0221
Contributor
I have a question. Can you code a 19301-58 partial mastectomy following a simple mastectomy when the path report recommends additional margins?
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Wiki re-excision for margins following simple mastectomy
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Pebbles1218
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re-excision of mastectomy site
Depending on the amount of tissue removed use 19120-58. If an extensive amount of tissue removed then use 19301-58.
Depending on the amount of tissue removed use 19120-58. If an extensive amount of tissue removed then use 19301-58.
janet0221
Contributor
Add'l question
Normally 19120 is used when there is no attention to adequate margins? In this case, that was the intent??
Normally 19120 is used when there is no attention to adequate margins? In this case, that was the intent??
Lesainc
Networker
Maybe I am having a bad brain moment, but I would look at 19120/5 as a procedure that needs margins and the 19301/2, the surgeon is not looking for margins. In the later code the surgeon is removing a bulk of tissue based on anatomical guideposts.
I recognize that even in the 19300's a surgeon can get sandbagged with a sneeky cancer, a margin comes back positive and they would need to go back for margins.
I recognize that even in the 19300's a surgeon can get sandbagged with a sneeky cancer, a margin comes back positive and they would need to go back for margins.
Lesainc
Networker
oh and I would look at this case as a 19301-58. Forgot to mention that.
See! Bad Brain Day!
See! Bad Brain Day!
igrigoras@iowaclinic.com
Networker
Operation Proposed: Excision of skin and subcutaneous tissue for involved inferior margin following right mastectomy.
Operation Done: Same (12 cm intermediate closure).
Preoperative Diagnosis: Involved anterior-inferior margin following mastectomy
The patient was brought to the operating suite and placed supine on the operating table. After smooth induction of general laryngeal mask airway anesthesia, the right breast was prepped and draped in sterile fashion. The midportion of her old incision was then identified and marked an ellipse encompassing the old incision. This measured 12 cm. We then made this elliptical incision using a 15 blade. I then started elevating an inferior flap using electrocautery. Took this down almost down to the level of the muscle, however, the area of concern was near our incision. We then dissected directly down to the underlying AlloDerm and then dissected the tissue off of the underlying AlloDerm patch. Once it was freed, it was oriented with a single stitch superior and a double stitch at the new superficial margin. Frozen section of this area revealed no evidence of tumor. The area was then irrigated with Betadine irrigation and then closed in layers. Deep dermal layer was closed using interrupted 3-0 Vicryl, skin closed using running subcuticular 4-0 Monocryl. Sterile glue was applied. She tolerated the procedure well, was taken to the postanesthesia care unit in good condition. Sponge, instrument, needle counts were correct at the conclusion of procedure.
What do you think about the above?
Operation Done: Same (12 cm intermediate closure).
Preoperative Diagnosis: Involved anterior-inferior margin following mastectomy
The patient was brought to the operating suite and placed supine on the operating table. After smooth induction of general laryngeal mask airway anesthesia, the right breast was prepped and draped in sterile fashion. The midportion of her old incision was then identified and marked an ellipse encompassing the old incision. This measured 12 cm. We then made this elliptical incision using a 15 blade. I then started elevating an inferior flap using electrocautery. Took this down almost down to the level of the muscle, however, the area of concern was near our incision. We then dissected directly down to the underlying AlloDerm and then dissected the tissue off of the underlying AlloDerm patch. Once it was freed, it was oriented with a single stitch superior and a double stitch at the new superficial margin. Frozen section of this area revealed no evidence of tumor. The area was then irrigated with Betadine irrigation and then closed in layers. Deep dermal layer was closed using interrupted 3-0 Vicryl, skin closed using running subcuticular 4-0 Monocryl. Sterile glue was applied. She tolerated the procedure well, was taken to the postanesthesia care unit in good condition. Sponge, instrument, needle counts were correct at the conclusion of procedure.
What do you think about the above?