Breast procedures guidelines, Summaries of Zoology

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Surgery Coding on Breast

Procedures

Anitha Jayaseelan, CPC, CIRCC

Disclaimer

This presentation is designed to offer basic information for

coding and billing. The information presented here is based

on the experience, training and 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 material is

intended as an Educational guide and should not be

considered a legal/consulting opinion.

Anatomy & Pathophysiology

❖ Anatomy and Pathophysiology

Anatomy & Pathophysiology

Anatomy of Breasts:

• The breasts are paired structures located on the anterior thoracic wall, in the pectoral region.
• The breast is composed of two regions: ▪ Circular body – largest and most prominent part of the breast. ▪ Axillary tail – smaller part, runs along the inferior lateral edge of the pectoralis major towards the axillary fossa.
• The breast is made up of lobes and ducts superimposed by subcutaneous adipose tissue fat.

Anatomy & Pathophysiology

Anatomy of Breasts:

• In females, the breasts contain the mammary glands – an accessory gland of the female reproductive system. The mammary glands are the key structures involved in lactation.
• Each breast has blood vessels and lymph vessels.
• The lymph vessels carry lymph fluid between lymph nodes.
• Lymph nodes are small, bean-shaped structures found throughout the body. They filter lymph fluid and store white blood cells that help fight infection and disease.

Anatomy & Pathophysiology

Anatomy of Breasts:

• Sentinel Node: A sentinel lymph node is “defined as the first lymph node to which cancer cells are most likely to spread from a primary tumor. Sometimes, there can be more than one sentinel lymph node.

Anatomy & Pathophysiology

Pathophysiology: Breast disorders may be noncancerous benign or cancerous malignant.

• Neoplasm- Benign, Malignant, CA in situ, etc.
• Intraductal papilloma ✓ Wart-like benign tumors that grow in the milk duct of the breast
• Fibrocystic changes ✓ Includes pain, lumpiness, thickening, and swelling often before the menses
• Cysts ✓ Fluid filled sacs
• Fibroadenomas ✓ Small, smooth, solid, rounded noncancerous lumps composed of fibrous and glandular tissue.
• Abscess

Anatomy & Pathophysiology

Pathophysiology: Breast disorders may be noncancerous benign or cancerous malignant.Common breast disease includes but not limited to:

• Nipple Discharge
• Hyperplasia
  • An overgrowth of the cells that line the lobules or ducts inside the breast. It is not cancer, but some types of hyperplasia are linked with a higher risk of developing breast cancer.
• Mastitis ✓ Painful inflammation of the breast, which is usually accompanied by a breast infection
• Complication of Surgery and Breast Implants ✓ Infection, rupture of implants, Bleeding, etc

Surgery Coding On Breast Procedures

Modifiers: Breasts are paired structures. Hence laterality modifiers are applicable as appropriate. LT Left side RT Right side 50 Bilateral Procedure Apart from the above, other modifiers are applicable modifiers as per the encounter.

Surgery Coding On Breast Procedures

Aspiration: The physician punctures the breast cyst with a sterile needle and drains the fluid from the cystic sac. 19000 Puncture aspiration of cyst of breast; +19001 each additional cyst

• This is a percutaneous procedure.
• Code imaging guidance separately if performed ➢ 76942 US ➢ 77021 MR

Surgery Coding On Breast Procedures

Evacuation of postoperative hematoma in reconstructed breast 21501 Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax

Surgery Coding On Breast Procedures

Mammary Ductogram: 19030 Injection procedure only for mammary ductogram or galactogram For radiological supervision and interpretation, see 77053, 77054 77053 Mammary ductogram or galactogram, single duct, radiological supervision and interpretation 77054 multiple ducts

Surgery Coding On Breast Procedures

Localization Devices: CPT Code Description 19281 Placement of breast localization devices eg, clip, metallic pellet, wire/needle, radioactive seeds, percutaneous; first lesion , including mammographic guidance +19282 each additional lesion, including mammographic guidance 19283 Placement of breast localization devices eg, clip, metallic pellet, wire/needle, radioactive seeds, percutaneous; first lesion , including stereotactic guidance +19284 each additional lesion, including stereotactic guidance 19285 Placement of breast localization devices eg, clip, metallic pellet, wire/needle, radioactive seeds, percutaneous; first lesion , including ultrasound guidance +19286 each additional lesion , including ultrasound guidance 19287 Placement of breast localization devices eg, clip, metallic pellet, wire/needle, radioactive seeds, percutaneous; first lesion , including magnetic resonance guidance +19288 each additional lesion , including magnetic resonance guidance

Surgery Coding On Breast Procedures

Localization Devices:

• Report the code based on the number lesions. Do not code based on the number devices placed.
• Because single lesion may require more than 1 devices.
• Add on codes must be reported for each additional lesion though the lesions are on the same breast or the contralateral breast.
• If the device is placed into 2 lesions one on the right and other on the left using the same type of imaging guidance, code a Primary CPT and an add-on code. Do not report the Primary CPT with 50 modifier or with RT & LT separately.