Breast Coding | Medycoding

Breast Coding Expert with Medycoding

Anatomy of breast (Source: Medycoding)

The breast is made up of fatty tissue and fibrous tissue, which help shape the breast and provide support. The breast contains lobes, lobule and duct.

To break it down:

Lobes: Large sections of the breast, each containing smaller lobules.
Lobules: Milk-producing glands within each lobe.
Ducts: Tubes that carry the milk from the lobules to the nipple.

Breasts contain a network of thin tubes called lymph vessels. These are connected to groups of small bean shaped structures called lymph nodes. The lymph node are part of immune system because it secretes wbc.

The lymph nodes that is closest to the breast near the axilla is called as axillary nodes.

The lymph nodes that are under the breastbone is internal mammary nodes and in the neck region is called as supraclavicular nodes.

Pectoralis Muscles (https://www.southernplasticsurgery.com/anatomy-of-the-female-breast/): The two pectoralis muscles are the muscles that create the majority of the chest and are found between the breast and the ribcage in the chest wall.

The pectoralis minor muscle is a thin, triangular muscle situated at the upper part of the chest beneath the pectoralis major. Primary actions include the stabilization, depression, abduction or protraction, upward tilt, and downward rotation of the scapula.

The pectoralis major muscle is a large, thick, fan-shaped muscle across the chest from the shoulder to the breastbone. Both pectorals are primarily used to control the movement of the arm and also play a part in profound breathing, pulling the ribcage to create space for the lungs to expand. A developed pectoralis major is most obvious in men, but typically a woman’s breasts hide the pectoral muscles.

What is sentinel Lymph nodes ?

A sentinel lymph node is the first lymph node to which cancer cells are likely to spread from a primary tumor.

Incision and Drainage

1.Puncture asipiration of cyst of breast (CPT-19000,+19001) (BL/LT/RT)

Puncture breast cyst with a syringe needle.
The needle is inserted into the cyst and fluid is evacuated into the syringe, thus reducing the size of the cyst.
The physician withdraws the needle and applies pressure to the puncture wound to stop bleeding.

Code imaging guidance separately

76942 : Ultrasound guidance

77021: Magnetic resonance imaging

77002: Fluroscopic guidance

77012: Computed tomography

19000: Puncture aspiration of cyst of breast

The provider drains out the fluid from a breast cyst by inserting a needle into it

+19001: Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure)

Incision and Drainage

2.Mastotomy with drainage of abscess (CPT-19020) (BL/LT/RT)

The physician makes an incision in the skin of the breast over the site of an abscess or suspicious tissue for exploration or drainage.
The infected cavity is accessed and specimens for culture are taken before the cavity is irrigated with warm saline solution.
Bleeding vessels may be tied or cauterized.
If no abscess or suspicious tissue is found, the wound is closed with sutures. In the case of an abscess, the wound is usually loosely packed with gauze to promote free drainage rather than being closed with sutures.
Intermediate/ Complex Repairs are included.

19020: Mastotomy with exploration or drainage of abscess, deep

The provider performs a mastotomy (incision into the breast) and explores and/or drains a deep abscess in the breast.

Note: Intraoperative placement of localization device cannot be coded separately so above localization device shows preoperative placement of localization device.

19020: Mastotomy with exploration or drainage of abscess, deep

The provider performs a mastotomy (incision into the breast) and explores and/or drains a deep abscess in the breast.

Note: Intraoperative placement of localization device cannot be coded separately so above localization device shows preoperative placement of localization device.

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

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

+19126 Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure)

Tips : This procedure does not include the placement of the localization device. For placement of localization devices in the breast, see 19281 through 19288.

19105 Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma

Note: If physician perform excision of breast tissue including margin then it will be coded as mastectomy.

Intraoperative placement of radilological marker is inclusive no need to code separately.

19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)

19302 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy

Note: When complete removal of lymph node is performed then we will give above code, if they remove few lymph node for biopsy then we will code biopsy of lymph node cpt code

19303 Mastectomy, simple, complete

Note: Skin-Sparing Mastectomy: Removes breast tissue but preserves most of the skin.
Nipple-Sparing Mastectomy: Preserves the nipple and areola while removing breast tissue.

Note: If physician perform excision of breast tissue including margin then it will be coded as mastectomy.

Intraoperative placement of radilological marker is inclusive no need to code separately.

19305 Mastectomy, radical, including pectoral muscles, axillary lymph nodes

19306 Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation)

19307 Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle

19300 Mastectomy for gynecomastia

19318 Breast reduction

1. Mastopexy (Breast Lift):

What it is: Mastopexy, commonly known as a breast lift, is a surgical procedure designed to lift and reshape sagging breasts by removing excess skin and tightening the surrounding tissue. It restores a more youthful, perky appearance.
Why it’s done:
- To address breast ptosis (sagging), which can occur due to aging, gravity, pregnancy, breastfeeding, or significant weight loss.
- It helps to restore breast symmetry and improve breast position.
- It may be combined with breast augmentation (implant placement) for added volume or fullness if the patient desires it.

2. Breast Reduction (Reduction Mammoplasty):

What it is: Breast reduction, also known as reduction mammoplasty, is a procedure that involves the removal of excess breast tissue (fat, glandular tissue, and skin) to reduce the size of large, heavy breasts and reshape them for a more balanced appearance.
Why it’s done:
- To alleviate physical discomfort associated with oversized breasts, such as neck, back, and shoulder pain, skin irritation, or difficulty with posture.
- To improve the proportions of the body and symmetry, especially if one breast is larger than the other.
- To improve physical activity or sports participation, as large breasts can interfere with mobility and comfort.

3. Breast Augmentation (Augmentation Mammoplasty):

What it is: Breast augmentation, also known as augmentation mammoplasty, is a procedure where breast implants (silicone or saline) are placed in the breasts to increase their size, improve their shape, or restore volume that may have been lost after pregnancy or weight loss.
Why it’s done:
- To increase breast size in women who feel their breasts are too small or asymmetrical.
- To restore volume lost after pregnancy or weight loss.
- To correct breast asymmetry.

19340 Insertion of breast implant on same day of mastectomy (ie, immediate)

19342 Insertion or replacement of breast implant on separate day from mastectomy

(Delayed reconstruction)

19357 Tissue expander placement in breast reconstruction, including subsequent expansion(s)

11970 Replacement of tissue expander with permanent implant

11971 Removal of tissue expander without insertion of implant

What is tissue expander ?

A tissue expander is typically placed before a breast implant in cases where there is significant tissue loss (due to surgery, trauma, or other factors), and the skin and soft tissue of the breast need to be stretched to accommodate the implant. This process allows the skin and muscle to gradually expand, creating enough space for the breast implant to be placed later.

19361 Breast reconstruction; with latissimus dorsi flap

19364 Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap)

19367 Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap

19368 Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous 19369 (TRAM) flap, requiring separate microvascular anastomosis (supercharging)

Breast reconstruction; with bipedicled transverse rectus abdominis myocutaneous (TRAM) flap

19350 Nipple/areola reconstruction

15771 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate

15772 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure)

19371 Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents

19370 Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy

19380 Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)
Notes:

Note: Removal of implant will not be code separately if physcian perform capsulectomy

19316 Mastopexy

The provider performs a mastopexy, also called a breast lift, which may involve removing excess skin of the breast and tightening surrounding tissue.

CMS Guideline

1.Mastectomy + breast excision codes (19110-19126) generally are notseparately reportable unless performed at a site unrelated to themastectomy.

2.Mastectomy + Sentinel Lymph node biopsy (38500 or 38525, Cervical lymphnodes biopsy (38510)- Code separately

3.CPT code 15734 (Muscle, myocutaneous, or fasciocutaneous flap, trunk) shall not be reported with breast reconstruction CPT codes (19357-19364)and 19367-19369) or breast prosthesis CPT codes(19340 and 19342) since a flap, is included in the reconstruction or prosthesis procedure.

4.Breast reconstruction procedures (CPT codes 19357- 19369) include Adjacent tissue transfer or rearrangement procedures if performed.

Other

Lymphoscintigraphy is a nuclear medicine imaging technique that uses a radioactive tracer to visualize the lymphatic system,

78195: Lymphatics and lymph nodes imaging

In this procedure, the provider uses a gamma–emitting radioactive tracer to diagnose and localize diseases of the lymphatics and lymph nodes.