tci General Surgery Coding Alert - 2006 Issue 6

You Be the Coder: When Does Excision Become Mastectomy?

Question: What is the line between codes 19120 and 19160? Does the surgeon have to document removal of a full 25 percent of the breast before I can report 19160?Michigan SubscriberAnswer: There is no clear percentage of tissue the surgeon must remove to report 19160 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy]) rather than 19120 (Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion [except 19140], open, male or female, one or more lesions). Instead, you should choose a code based more on the surgeon's intention to...

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