AHA Coding Clinic® for HCPCS - 2017 Quarter 3; Ask the Editor
Chest reconstruction after bilateral mastectomies
A patient with history of breast cancer and bilateral mastectomies opted out of reconstruction and is now being seen at our facility for chest reconstruction due to contour issues of her chest with indented painful scars and redundant skin at the mastectomy sites. The areas of redundant skin and scar tissue measure 22 cm x 4 cm on the right and 20 cm x 5 cm on the left. These were excised down to the subcutaneous fat overlying the pectoralis major muscle. Skin flaps were elevated from the upper abdomen allowing for advancement on the right and left chest and the skin was closed via staples. The fat from the abdomen and flanks was harvested and placed in syringes for the administration of fat to the areas of defect. Once the fat was administered, the incisions were closed. The previous mastectomy scars were treated. The right chest scar was injected with 0.4 cc of Kenalog and the left chest scar was excised (full thickness) and also injected with Kenalog. All incisions were closed. Our facility wants to report CPT codes 13100 and 13102 x 7 due to the scar revision, 19366 for the fat grafting, 11900 for the Kenalog injections. Are these the correct codes? ...
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Article Overview
This article focuses on post-mastectomy chest reconstruction in a patient with a breast cancer history and prior bilateral mastectomies. It covers the operative approach used to address contour deformity, painful scarring, redundant skin, flap advancement, fat transfer to defects, and treatment of prior mastectomy scars. The content is relevant to coding professionals working with breast/chest reconstruction procedures and related surgical coding decisions.
Why This Topic Matters
Post-mastectomy reconstruction can involve multiple distinct operative components that affect code selection and documentation review. Understanding the scope of the procedure helps coding staff identify the relevant surgical services and distinguish reconstruction work from scar treatment and tissue transfer.
What You Will Learn
- The general clinical scenario of chest reconstruction after bilateral mastectomy
- How reconstructive breast/chest procedures may combine excision, flap advancement, and fat transfer
- How scar treatment may be part of a broader reconstruction operative note
- What kinds of documentation details are relevant for reviewing post-mastectomy reconstruction cases
Who Should Read This
- Medical coders
- Coding auditors
- Physician documentation reviewers
- Revenue cycle staff
- Plastic surgery billing staff
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