When a sentinel node biopsy is done followed by a modified radical mastectomy, should code 40.23, Excision of axillary lymph node, be assigned for the sentinel node biopsy, along with code 85.43, Unilateral extended simple mastectomy? A “simple mastectomy with excision of regional lymph nodes” is an inclusion at code 85.43....
#3 19303 is a simple mastectomy, and does cover the description above. Sentinel Axillary Lymph Node Biopsy is 38525. There is a CPT Assist article that directs you to use the deep node codes for sentinal node biopsies.
When the surgeon performs a sentinel lymph node biopsy prior to an unplanned partial mastectomy (either with or without lymphadenectomy) and the subsequent excisions are a result of biopsy findings, you may report the sentinel node biopsy separately.
CPT code 38500 is reported for open excision or biopsy of superficial lymph nodes - these nodes are usually palpable under the skin. Levels II and III are deep and reported with CPT code 38525 (open, deep axillary nodes). The depth of dissection should be documented in the op note for coding accuracy.
Example: The surgeon takes a biopsy of the sentinel axillary node (38525, Biopsy or excision of lymph node [s]; open, deep axillary node [s]). The pathology report indicates that the malignancy has spread, so the surgeon follows up with a lymphadenectomy (for example, 38745, Axillary lymphadenectomy; complete) to remove the affected tissue.
Deep excision or biopsy (38525) is inclusive of superficial excision or biopsy (38500) at the same location, but either 38500 or 38525 may be reported in addition to 19301. 19301 and 38745. Complete axillary lymph node dissection also may accompany a partial mastectomy.
I keep reading you would code 19302, if not a complete axillary lymphadenectomy and contents were done AND if it was done a separate incision. You would code 19301 if the lymph nodes were taken through the same incision.
CPT 19125 the lesion is identified by preoperative placement of radiological marker. 19301 is a partial mastectomy or lumpectomy. There is also NO radiological marker placement.
Encounter for breast reconstruction following mastectomy Z42. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z42. 1 became effective on October 1, 2021.
Report code 19303, Mastectomy, simple, complete, for the mastectomy.
38900 is identified in your CPT® book as an add on code which means it cannot be billed by itself seperatly. There fore you have to have a primary code to bill with first such as 38792.
Biopsy or excision of lymph node(s) is an inherent part of CPT code 19302. To report the work associated with the intraoperative identification of the sentinel node, report add-on code 38900.
CPT® Code 19301 in section: Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)
The breast surgery Current Procedural Terminology (CPT) codes were developed when axillary dissection was standard therapy for breast cancer. Modified radical mastectomy is coded 19307; lumpectomy with axillary dissection is coded 19302.
Z90. 12 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z90. 12 became effective on October 1, 2021.
2022 ICD-10-PCS Procedure Code 0HBV0ZZ.
Z40. 01 - Encounter for prophylactic removal of breast | ICD-10-CM.
90863. PHARMACOLOGIC MANAGEMENT, INCLUDING PRESCRIPTION AND REVIEW OF MEDICATION, WHEN PERFORMED WITH PSYCHOTHERAPY SERVICES (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE)
If a percutaneous breast biopsy is performed using both stereotactic and tomosynthesis imaging guidance, CPT code 19081 (Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ...
we code these as 19301 with a modifier 78 and have no trouble getting paid.
If a psychiatric diagnostic evaluation with medical assessment is performed, the physician or NPP may use CPT code 90792 or an evaluation and management (E/M) code.