KatiWhite
Networker
My physician started a Vacora breast biopsy but after inserting the needle had to abort the procedure. See operative note below.
After obtaining informed consent, the breast was prepped and draped in the usual sterile manner. Ultrasound was performed and the nodule / lesion was noted in the area of the breast as previously noted. Local anesthetic was used to infiltrate the skin and surrounding soft tissue. An 11 blade was then used make a small skin incision. At this point dark blood started to flow from site. Pressure applied for over 5 minutes. Bleeding persisted and hematoma formed (moving the target lesion). Vacora needle started to be inserted to aspirate hematoma / possible obtain biopsy but area tender and hematoma expanding (likely inaccurate biopsy). Hematoma aspirated under ultrasound guidance (7 ml blood) and pressure re-applied with slowing of bleeding. Procedure aborted due to risk of ongoing bleeding and technical difficulty of performing biopsy without surround hematoma. Pressure dressing applied. Will see patient back in 2 days. Biopsy will have to be delayed several weeks until hematoma resolved. Will consider excisional biopsy under local anesthetic vs core needle with different approach (lateral approach used today).
I have tried billing the AHCCCS plan with modifier 53 and mod 52 and both are denying. He feels he should get reimbursed for something as he had to open and use the expensive vacora needle. Does anyone have any suggestions?
After obtaining informed consent, the breast was prepped and draped in the usual sterile manner. Ultrasound was performed and the nodule / lesion was noted in the area of the breast as previously noted. Local anesthetic was used to infiltrate the skin and surrounding soft tissue. An 11 blade was then used make a small skin incision. At this point dark blood started to flow from site. Pressure applied for over 5 minutes. Bleeding persisted and hematoma formed (moving the target lesion). Vacora needle started to be inserted to aspirate hematoma / possible obtain biopsy but area tender and hematoma expanding (likely inaccurate biopsy). Hematoma aspirated under ultrasound guidance (7 ml blood) and pressure re-applied with slowing of bleeding. Procedure aborted due to risk of ongoing bleeding and technical difficulty of performing biopsy without surround hematoma. Pressure dressing applied. Will see patient back in 2 days. Biopsy will have to be delayed several weeks until hematoma resolved. Will consider excisional biopsy under local anesthetic vs core needle with different approach (lateral approach used today).
I have tried billing the AHCCCS plan with modifier 53 and mod 52 and both are denying. He feels he should get reimbursed for something as he had to open and use the expensive vacora needle. Does anyone have any suggestions?