Joyce Burchett
Networker
This is 2nd surgery on case I posted yesterday 4/17. Need help from any plastic surgery coders. Hx of mastectomy with Lt breast tissue expander with seroma formation in the distal portion of the Lt lateral breast.
Procedures: Removal & Replacement Lt Breast Tissue Expander; Lt Breast Mound Revision; Removal Lt Breast Alloderm; Drainage of Breast Sarcoma
Previous transverse incision was opened & carried down through the skin & subcutaneous tissues until the end-point capsule was noted. The junction where the alloderm was sutured to the inferior portion of the pectoralis was released. About 200 mL seroma was drained. There was some fibrinous tissue that was note grossly infected; however, cultures were sent. The alloderm actually was adherent to the breast flap. However, we elected to excise this in its entirety. It was bascially removed from the inferior aspect of the pectoralis to the inframammary fold. Wound was copiously irrigated & instilled with antibiotic solution. Tissue expander was then placed & filled with 150 mL of saline. The inferior subcutaneous tissue portion of breast capsule, deep dermis & skin were all closed. Prior to closure a Blake drain placed. Attention then directed to the lateral breast. There was a fair amount of excess tissue from previous flaps. This was incised, measuring about 12 x 6 cm, sent for specimen & then closed, thus revising the breast mound.
Procedure was coded 19357-LT, 19380 51-LT, 11971 51-LT, & 10140-51.
I don't feel that this is correct--I read that you should not use 19380 which is intended to be used for revison of a previously reconstructedbreast. The breast is not considered to be finally reconstructed at the time of exchange. It is only after the breast has undergone complete reconstruction that you can use 19380. I also don't think we should use 11971 since we removed the expander & replaced it. Also 10140 should not be coded. Not sure what to do for lateral breast excess tissue removal. Anyone willing to help or discuss this one? This surgery was 1 month after lst surgery.
Procedures: Removal & Replacement Lt Breast Tissue Expander; Lt Breast Mound Revision; Removal Lt Breast Alloderm; Drainage of Breast Sarcoma
Previous transverse incision was opened & carried down through the skin & subcutaneous tissues until the end-point capsule was noted. The junction where the alloderm was sutured to the inferior portion of the pectoralis was released. About 200 mL seroma was drained. There was some fibrinous tissue that was note grossly infected; however, cultures were sent. The alloderm actually was adherent to the breast flap. However, we elected to excise this in its entirety. It was bascially removed from the inferior aspect of the pectoralis to the inframammary fold. Wound was copiously irrigated & instilled with antibiotic solution. Tissue expander was then placed & filled with 150 mL of saline. The inferior subcutaneous tissue portion of breast capsule, deep dermis & skin were all closed. Prior to closure a Blake drain placed. Attention then directed to the lateral breast. There was a fair amount of excess tissue from previous flaps. This was incised, measuring about 12 x 6 cm, sent for specimen & then closed, thus revising the breast mound.
Procedure was coded 19357-LT, 19380 51-LT, 11971 51-LT, & 10140-51.
I don't feel that this is correct--I read that you should not use 19380 which is intended to be used for revison of a previously reconstructedbreast. The breast is not considered to be finally reconstructed at the time of exchange. It is only after the breast has undergone complete reconstruction that you can use 19380. I also don't think we should use 11971 since we removed the expander & replaced it. Also 10140 should not be coded. Not sure what to do for lateral breast excess tissue removal. Anyone willing to help or discuss this one? This surgery was 1 month after lst surgery.