egraham0824
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I have a surgery and I am wanting to bill 19316, 11403, 12034. However I am questioning if the 11403 and 12034 would be included with 19316. Patient has history of Right Breast cancer and was reconstructed and now has breast asymmetry. He does do seperate areas and closures but I am getting a bundling edit and just want another thought on this. Below is information from the report for review.
PROCEDURE(S):
1) Revision of breast reconstruction (LEFT)
2) Excision of skin and fat, chest wall (3 X 1 cm) with complex closure (3 cm) (midline)
The left breast was revised first. The patient was placed in the upright sitting position and the exact areas of deformity were identified. These were located excess volume and projection. The result of the nipple was long on this side measuring approximately 12 cm compared to the contralateral reconstructed breast where the location of the nipple would be anticipated at approximately 8 cm above the inframammary fold.. The breast was revised by excising the previous wise pattern scars across a very fold and the vertical portion up to the margin of the nipple areolar complex. The immobilizer from the surface of the capsule surrounding a previously placed breast implant. The breast was elevated off the pectoralis major muscle to above the level of the breast implant. The tissue on the deep surface of the breast flaps was excised is serially of the flap is is a breast implant and dress major muscle to assess volume symmetry with the contralateral side. Hemostasis was achieved with electrocautery. After an adequate amount of tissue was excised the flaps were trimmed at the distal edge to allow 8 cm from the nipple to the inframammary fold. The wounds were the closed with 3-0 Polysorb suture the dermis and a running suture of 4 Biosyn. At this point it appeared that the entire breast was more ptotic after reducing the volume. Tailor taking sutures were used to determine the proper location of the nipple on the new breast mound. Approximately 5 cm of elevation was necessary. A crescentic area of skin was de-epithelialized above the nipple and the nipple elevated by approximating the margin of the areola to the upper breast skin flap. The nipple was secured with 3-0 PolySorb suture on the dermis and a running simple suture of 4-0 nylon on the skin. The nipple was well-perfused after mobilization and elevation. The remaining wounds were closed with 3-0 Polysorb on the dermis and a running subcuticular suture of 3-0 Biosyn in the skin.
At this point the chest wall contour deformity was revised. Between the breasts there was a fold of skin causing a hooded deformity extending from hte medial inframammary fold of the left breast to the contralateral breast. Excision required removal of tissue proximally 1 cm wide by 3 cm in length. The skin was incised in a elliptical fashion. This was carried down with electrocautery through the dermis. The subcutaneous fat was excised with electrocautery and sharp dissection in a tapering fashion from medial to lateral. This wound was then closed in layers with 3-0 Polysorb on the dermis and a running subcuticular suture of 3-0 Biosyn in the skin. This closure was in continuity with the inframammary closure.
PROCEDURE(S):
1) Revision of breast reconstruction (LEFT)
2) Excision of skin and fat, chest wall (3 X 1 cm) with complex closure (3 cm) (midline)
The left breast was revised first. The patient was placed in the upright sitting position and the exact areas of deformity were identified. These were located excess volume and projection. The result of the nipple was long on this side measuring approximately 12 cm compared to the contralateral reconstructed breast where the location of the nipple would be anticipated at approximately 8 cm above the inframammary fold.. The breast was revised by excising the previous wise pattern scars across a very fold and the vertical portion up to the margin of the nipple areolar complex. The immobilizer from the surface of the capsule surrounding a previously placed breast implant. The breast was elevated off the pectoralis major muscle to above the level of the breast implant. The tissue on the deep surface of the breast flaps was excised is serially of the flap is is a breast implant and dress major muscle to assess volume symmetry with the contralateral side. Hemostasis was achieved with electrocautery. After an adequate amount of tissue was excised the flaps were trimmed at the distal edge to allow 8 cm from the nipple to the inframammary fold. The wounds were the closed with 3-0 Polysorb suture the dermis and a running suture of 4 Biosyn. At this point it appeared that the entire breast was more ptotic after reducing the volume. Tailor taking sutures were used to determine the proper location of the nipple on the new breast mound. Approximately 5 cm of elevation was necessary. A crescentic area of skin was de-epithelialized above the nipple and the nipple elevated by approximating the margin of the areola to the upper breast skin flap. The nipple was secured with 3-0 PolySorb suture on the dermis and a running simple suture of 4-0 nylon on the skin. The nipple was well-perfused after mobilization and elevation. The remaining wounds were closed with 3-0 Polysorb on the dermis and a running subcuticular suture of 3-0 Biosyn in the skin.
At this point the chest wall contour deformity was revised. Between the breasts there was a fold of skin causing a hooded deformity extending from hte medial inframammary fold of the left breast to the contralateral breast. Excision required removal of tissue proximally 1 cm wide by 3 cm in length. The skin was incised in a elliptical fashion. This was carried down with electrocautery through the dermis. The subcutaneous fat was excised with electrocautery and sharp dissection in a tapering fashion from medial to lateral. This wound was then closed in layers with 3-0 Polysorb on the dermis and a running subcuticular suture of 3-0 Biosyn in the skin. This closure was in continuity with the inframammary closure.
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