Notes from Dr. Borkosky

 |  Submit the case in a bucket designated for “breast”, “fat”, or “16 hour” processing (all of these mean the same thing). Small re-excisions (up to four or five cassettes) can be submitted in toto.

Multiple wires may be placed to identify any lesion. When a total mastectomy with sentinel node biopsy is performed, I obtain a frozen section of the nodes and proceed to dissect the axilla if positive. Di Saverio S, Catena F, Santini D, Ansaloni L, Fogacci T, Mignani S, Leone A, Gazzotti F, Gagliardi S, De Cataldis A, Taffurelli M. Breast Cancer Res Treat. Hello everyone, I have a re-excision coming up at the end of this month.

While some surgeons will refer to taking “margins of tissue” around the mass others will describe something that means the same thing without ever using the word margin (this is a good example of a statement that does not use the word margin but does describe attention to margins). How do you code for ablation of breast lesions with cryotherapy, microwave, RFA, or laser? Use code 19301-58 for lumpectomy with modifier for “staged/related procedure in the postoperative period.” Indicate in the operative report that this procedure is a planned return to the operating room for a more extensive work. In a re-excision, the surgeon goes back to the site of a prior partial mastectomy to take more tissue from a margin that was close.

Breast tissue with giant cell reaction, no tumor seen. Stay informed about current research, online events, and more. Epub 2018 May 21.

For CPT 19120, the physician is excising the breast mass alone.

This sentence further confirms the surgeon’s “attention to margins” but even without this sentence, the first statement about taking additional tissue to ensure adequate resection would support attention to margins. Could I code for the X ray of the operative specimen with CPT code 76098? Logistic regression was used to identify factors that were predictive of a positive margin; predictors of local recurrence in women whose tumors were completely resected were determined using Cox's proportional hazards model. Patient to follow up in the office in 7-10 days for suture removal and to receive final pathology results and discuss treatment options. The only independent predictor of local recurrence in our study cohort was large tumor size. When a code allows modifier 50, the laterality modifiers RT or LT would apply to that same code when the procedure described by the code is performed only on one side.

The goal of this study was to identify characteristics that distinguish breast biopsy specimens with positive margins that when reexcised are free from residual tumor. Patients in groups A, B, and C differed with respect to mean age at diagnosis (58 years, 51 versus, and 56 years, respectively, p < 0.0001), mean tumor size (19 mm, 16 mm, and 26 mm, respectively, p < 0.0001), node positivity (30%, 22%, and 41%, respectively, p = 0.004), and the presence of a ductal carcinoma in situ (DCIS) component (60%, 64%, and 79%, respectively, p = 0.007). A retrospective search of the Henrietta Banting Breast Centre database from 1987 to 1997 identified 1430 patients who underwent lumpectomy for invasive breast cancer: 1225 patients (group A) had negative margins at the initial surgery and 152 patients (group B) underwent one or more reexcisions to achieve negative margins. Special Report: COVID-19’s Impact on Breast Cancer Care, Talking to Your Family and Friends About Breast Cancer, Fertility and Pregnancy Issues During and After Breast Cancer, Understanding Breast Cancer Risk and How to Lower It, Taking Certain Supplements Before and During Chemotherapy for Breast Cancer May Be Risky, Tamoxifen (Brand Names: Nolvadex, Soltamox). CPT 19120 is reported only once per breast whether one or more lesions are removed. Can I code for injection of radioactive tracer and blue dye for sentinel lymph node biopsy?

That rim of normal tissue removed around the mass is called a margin (meaning “the edge”) because that normal tissue removed is around the outside edge of the mass in the final specimen removed.

If cancer cells are found in the margins extending out to the edge of the breast tissue that was removed, your surgeon will perform additional surgery (called re-excision) to remove the remaining cancer. It was helpful.Medical Coding Jobs for Pharmacy Freshers. Talk to our breast care nurses 0808 800 6000. This website uses cookies. Take a second to support Kimberly Mansingh on Patreon! Told Stage 0, Grade pre-cancer Recommendation: Mastectomy, radiation 5 wks, Arimidex for 5 years.

Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. By clicking OK, you consent to the use of cookies.

Coding for Example #1: The bolded portions of the note above are clues to selecting our CPT code. The Payer and Patient Cost Burden of Open Breast Conserving Procedures Following Percutaneous Breast Biopsy.

The surgical margin status after breast-conserving surgery: discussion of an open issue. This documentation supports CPT 19120. Is Lumpectomy Plus Radiation Right for You?  |  This reference to the word “margin” does not automatically make this procedure a lumpectomy because it does not refer to the intent to obtain negative margins by taking a rim of normal tissue around the breast mass to ensure no diseased tissue remains after surgery. ACS General Surgery Coding and Reimbursement Committee.

So how do you distinguish between the two codes and know which CPT to pick? CPT codes 19120 and 19125 are used for excision of breast lesions, where attention to surgical margins and assurance of complete tumor resection is unnecessary. After sterile prep and drape, a curvilinear incision was made in the vicinity of the mass in the upper outer quadrant of the right breast.

Medical Coding Jobs for Pharmacy Freshers. The CPT code for cryotherapy of fibroadenomas is 19105. We also see the term “partial” following the word mastectomy clarifying that, while different terms may be used to describe the procedure represented by CPT 19301, including lumpectomy, quadrantectomy, etc., all of these procedure include removal of “part” of the breast rather than removal of the entire breast.

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