mastectomy

How to Code Mastectomy & Breasts reconstruction procedures

Breast procedures (19000-19499) are divided according to category of procedure.

  1. Incision – 19000 – 19030
  2. Excision – 19081- 19272
  3. Introduction – 19281 – 19298
  4. Mastectomy – 19300 – 19307
  5. Repair and Reconstruction – 19316 – 19396

Percutaneous breast biopsies are reported with 19081-19086 based on the guidance method.

A location device (clip, metallic pellet, wire, needle, radioactive seed) placed without a biopsy is reported with 19281-19288 based on the guidance method.

mastectomy
breast reconstruction

Mastectomy  –  There are many mastectomy codes, and you need to carefully review the operative report to confirm whether pectoral muscles, axillary lymph nodes, or internal mammary lymph nodes were also removed. This information will be necessary to determine the correct mastectomy code.

Mastectomy for gynecomastia — This procedure is performed for treatment of gynecomastia. Gynecomastia is an abnormal condition of large breasts in males. In this procedure, the excess breast tissue is removed. Use code 19300 to report mastectomy for gynecomastia. This is a gender specific code and should be coded for male patients only.

Partial mastectomy – 19301  when only a portion of the breast tissue is removed. The surgeon may also refer to a partial mastectomy as a lumpectomy, quadrantectomy , tylectomy or segmentectomy

 If an axillary lymphadenectomy (sentinel node or other axillary node excision)is performed with a partial mastectomy, report the service with 19302.

Simple or complete mastectomy – 19303 when all of the subcutaneous tissue and breast tissue are removed and the nipple and skin may or may not be removed.  skin and muscle is left but all the breast tissue is removed.

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Radical mastectomy – 19305 when entire breast is removed in addition to the pectoral muscles and axillary lymph nodes. Code 19306 reports another type of radical mastectomy that includes the internal mammary lymph nodes and is also known as an Urban type operation. When both axillary lymph nodes and the internal mammary lymph nodes are taken during this operative session, the pectoralis major and minor can be spared

Modified radical mastectomy – 19307  when breast is removed in addition to the axillary lymph nodes, and the pectoralis minor muscle may or may not be removed. The pectoralis major muscle is not removed in the modified radical mastectomy.

19316-19396 – For Breats Repair and reconstruction.

  • Breast reduction – 19318
  • Augmentation ,Breast enlargement – 19324, 19325
  • Breast reconstruction – 19357-19369

Reconstruction for 19357 includes the insertion of a tissue expander and the subsequent expansion. The tissue expander is placed to stretch the skin overlying the breast to allow for insertion of a permanent prosthesis.

Latissimus dorsi flap (19361) describes a procedure during which muscle and skin are taken from the patient’s back and used to reconstruct a breast. The tissue is attached to the chest wall and surrounding muscles to allow for a complete and more natural appearance.

mastectomy
mastectomy

TRAM reconstruction involves using the skin and muscles from the abdomen to create a breast. The advantage to this technique is that the tissue remains attached to its blood supply. For a single pedicle flap, report 19367. If the surgeon uses two pedicles of the rectus abdominis, report 19369. When the flaps are performed with microvascular anastomsis for the connection of additional blood vessels, you should call on 19368. Note that these codes include closure of the donor site.

Lastly, a free flap reconstruction (19364) occurs when skin, fat and muscle from any other area of the patient are taken to construct an aesthetically pleasing breast.

Important Guidelines

  1. Mastectomy procedures are unilateral procedures. To report bilateral performance, add modifier 50.
  2. Placement of fiducial marker is inclusive to code 19301.
  3. Reporting of axillary lymph node dissection during partial mastectomy (code 19302) does not depend on the incision made for axillary dissection but the extent of axillary node dissection.
  4. 38500, Biopsy or excision of lymph node(s); open, superficial and 38525, Biopsy or excision of lymph node(s); open, deep axillary node(s) should be reported for removal/sampling of few sentinel nodes without complete axillary dissection, as appropriate.

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