Coding Breast Procedures Lynn Pegram, CPC, CPC-I, CGSC, CEMC Mid-Atlantic Coding, LLC www.codingpros.net [email protected] 804-474-3325 Disclaimer This material is designed to offer basic information on coding for breast procedures. This information is based on the experience, training, and the interpretation of the author. Although the information has been carefully researched and checked for accuracy and completeness, the instructor does not accept any responsibility or liability with regard to errors, omissions, misuse, or misinterpretation. This handout is intended as an educational guide and should not be considered a legal/consulting opinion. BREAST PROCEDURES Non-Invasive Breast Procedure Mammotome Breast Biopsy PROCEDURE: MAMMOTOME BREAST BIOPSY Pre-op Dx: Mass, right breast Post-op Dx: Mass, right breast Surgeon: Dr Addison Montgomery Anesthesia: Local CODING SOLUTION: CODES: 19103 – RT – Percutaneous automated vacuum assisted biopsy device; using imaging guidance 19295 – Image guided placement, metallic localization clip, percutaneous 76942 - Ultrasonic guidance for needle placement (biopsy, aspiration, localization device) Coding Scenario Left Simple mastectomy with inraoperative lymphatic mapping and left axillary sentinel node dissection. Codes: 19303-LT (174.4) 38525-LT (229.0) 38900 (229.0) Left simple mastectomy with intraoperative lymphatic mapping and left axillary sentinel node dissection. Codes: 19303-LT - Total/Simple Mastectomy 38525-LT - Excision Axillary Node 38900 - Mapping of Sentinel Node Rationale: This was coded as simple (Total) mastectomy. The 38525 is coded for the sentinel node excision. The 38900 is for the mapping of the node. Coding Scenario Partial Right Mastectomy w/positive sentinel node biopsy, Complete Axillary Node Dissection w/lymphatic mapping. Codes: 19302-RT (174.2) (196.3) 38900 (196.3) Coding Scenario Total Left Mastectomy w/positive sentinel node biopsy, complete axillary node dissection and lymphatic mapping. Codes: 19307-LT (174.3) (196.3) 38900 (196.3) Coding Scenario Bilateral Simple Mastectomy, Right Breast Cancer, Left Prophylactic Codes: 19303-RT (174.4) 19303-59LT (V50.41) (V16.3) Coding Scenario Bilateral Mastectomies w/bilateral sentinel node biopsies w/lymphatic mapping that came back negative Codes: 19303-50 (174.2) 38525-50 ( 229.0) 38900 x 2 (229.0) Coding Scenario Right Needle Loc Breast Biopsy for a Breast Mass Code: 19125-RT (611.72) A Week Later Right Partial Mastectomy for Carcioma Insitu Code: 19301-58RT ( 233.0) Coding Scenario Right Breast Cyst Aspiration x 4 w/ultrasound guidance Codes: 19000 – RT (610.0) 19001 x 3 76942-26 Question And Answer Thank You and enjoy the rest of your conference!