Coding 19120 vs 19301

Question:

What’s the difference between code 19120, breast mass excision and 19301, partial mastectomy/lumpectomy?

Answer:

Both codes describe the excision of a lesion in the breast.  Code 19120 is describes the excision or open removal of a cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion.

In contrast, code 19301 also describes removal of a lesion by performing a partial mastectomy, for example a lumpectomy, tylectomy, quadrantectomy, or segmentectomy.However, this code requires the necessity and documentation of attention to the removal of adequate surgical margins surrounding the breast mass or lesion.

*This response is based on the best information available as of 05/03/18.

Right Colectomy and Small Bowel Resection

Question:

The surgeon did a right colectomy and also documented a resection of the ileum. Is this billed separately as a small bowel resection?

Answer:

No. The resection of the ileum and anastomosis of the new end of the ileum (the neoterminal ileum) to the remaining colon (an ileocolostomy) is included in the code; 44160 for open and 44205 if performed laparoscopically.

*This response is based on the best information available as of 03/29/18.

Coding a Skin or Nipple Sparing Mastectomy

Question:

What is the appropriate code for a complete skin sparing or complete nipple sparing mastectomy?

Answer:

The code for a mastectomy described as complete skin sparing or complete nipple sparing mastectomy is 19303.

*This response is based on the best information available as of 04/19/18.

Breast Cyst Aspiration

Question:

The surgeon did a fine needle aspiration of two cysts in the same breast without any imaging. Is this billed once or twice?

Answer:

Fine needle aspiration of a breast cyst is reported per cyst. In this scenario, code 10021 with 2 units or 10021 and a second 10021 with a 59 or XS modifier as directed by your payor.

The fine needle aspiration codes are shown below.

Fine Needle Aspiration (FNA)

CPT Code	Description
10021	Fine needle aspiration; without imaging guidance
10022	with imaging guidance

Global Period for both codes – XXX*XXX means the concept of global period does not apply

*This response is based on the best information available as of 02/01/18.

Laparoscopic Pyloroplasty Coding

Question:

How is a laparoscopic pyloroplasty reported?

Answer:

There is no current CPT code laparoscopic pyloroplasty, only an open code. An open code may not be used if a procedure is done laparoscopically. An unlisted code must be used. In this case, use code 43659, unlisted laparoscopic procedure, stomach.

*This response is based on the best information available as of 01/18/18.

Billing an Appendectomy with Another Surgery

Question:

Is an appendectomy separately reported when done with another abdominal procedure?

Answer:

If the appendectomy is performed for a medically indicated purpose, for example the appendix was involved in the disease process, it can be reported with an add-on code, +44955. See the description of this code below. No modifier would be appended to this code and you should expect 100% reimbursement since add-on codes are valued lower since they are always reported with another procedure.

44955: Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure

*This response is based on the best information available as of 01/04/18.