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CPT Coding for Excisions and Partial Mastectomy 2012

Alert Details

Excisional breast surgery includes certain biopsy procedures, the removal of cysts or other benign or malignant tumors or lesions and the surgical treatment of breast and chest wall malignancies. Biopsy procedures may be percutaneous or open, and they may involve the removal of differing amounts of tissues for diagnosis.

  • Breast biopsy codes are reported using codes: 19100-19103
  • Open excision of breast lesions are reported using codes: 19110-19126
  • Partial mastectomy procedures are reported using codes: 19301 or 19302

Codes for excision of breast lesions and partial mastectomy procedures both describe open excisions of breast tissue. However, the partial mastectomy procedures also include removal of adequate surgical margins surrounding the breast mass or lesion.

Open Excision of Breast Lesions

19120: Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions *

  • Includes lesions of the breast ducts, cysts, benign or malignant tumors
  • Includes excision without specific attention to adequate surgical margins
  • For excision identified by preoperative placement of radiological markers: see codes 19125 and 19126

19125: Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion

19126: Each additional lesion separately identified by a preoperative radiological marker (list separately in addition to code for primary procedure)

  • Use 19126 in conjunction with 19125

Partial Mastectomy Procedures

19301: Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy)

  • Describes open excisions of breast tissue with specific attention to adequate surgical margins
  • Documentation should include removal of adequate surgical margins surrounding the breast mass or lesion **
  • Margins do not have to be a specific size to qualify for partial mastectomy
  • Margins must only be "adequate" to ensure the surgeon removes possible malignant tissue surrounding the excised mass

19302: Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy)with axillary lymphadenectomy

  • For partial mastectomy and lymphadenectomy performed during the same operative session ***
  • Axillary lymphadenectomy includes removal of the lymph nodes between the pectoralis major and the pectoralis minor muscles
  • Surgeon may also remove the nodes in the axilla through a separate incision at the same time
  • All identifiable axillary lymph nodes are removed, while retaining the pectoralis musculature
  • If the surgeon also resects the pectoralis musculature along with the axillary lymphadenectomy- do not code 19302. Choose code from 19305-19307.

Coding Tips

  • If the surgeon removes only the tumor and no or very little margin, code the excision (19120).
  • If the surgeon removes a breast lesion along with a margin of healthy tissue, code the partial mastectomy code (19301).
  • If the surgeon removes a breast lesion along with a margin of healthy tissue and axillary lymph nodes, code the partial mastectomy with lymphadenectomy code (19302)
  • If the surgeon removes only the lesion with minimal margins (19120) but the pathology report reveals malignancy and the surgeon must return the patient to the operating room and remove additional tissue, code the follow-up procedure using the partial mastectomy code (19301) with modifier 58 for staged or related procedure or service by the same physician during the postoperative period.

Sources:

* 2012 CPT Professional Edition

** General Surgery Coding Alert: Will New Mastectomy Codes Revolutionize Your Claims? Find Out Now. January 2007

*** General Surgery Coding Alert: Choosing Between 19301 vs. 19302. 2009; Volume 11, Number 7


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