Resolved Axilla Excision

[RachelA_80432]

Would an excision of the left axilla arm pit mass down to the fascia with a size of 7x8cm be 23073?
Provider also did a complex advancement flap 7x6cm closure 14031.

Since the excision is down to the fascia I would code both the excision and the advanced closure?

Provider stated he excised a fatty mass and path report states mass is just breast tissue.
Or do i only report the complex flap that includes the excision?

I thought if it was deep into the fascia to use the 23073 but then the advancement flaps also includes excision.
So I would code both since the the flap would only cover full thickness and down to the fascia..

23073-lt, 14031; Q83.1

 

[Darcy]

Would an excision of the left axilla arm pit mass down to the fascia with a size of 7x8cm be 23073?
Provider also did a complex advancement flap 7x6cm closure 14031.

Since the excision is down to the fascia I would code both the excision and the advanced closure?

Provider stated he excised a fatty mass and path report states mass is just breast tissue.
Or do i only report the complex flap that includes the excision?

I thought if it was deep into the fascia to use the 23073 but then the advancement flaps also includes excision.
So I would code both since the the flap would only cover full thickness and down to the fascia..

23073-lt, 14031; Q83.1

Soft tissues include subcutaneous fat and connective tissue, fascia, muscles, tendons, blood vessels, lymph vessels, nerves, and tissues surrounding the joints. Soft tissue tumors may be benign or malignant. Benign tumors are typically treated by excision, although small malignant or indeterminate tumors may be excised if the margins are well defined. Depending on the location of the tumor in the soft tissue of the shoulder area, the skin over the tumor may be incised or a skin flap created and elevated. Overlying tissue is dissected and the soft tissue mass exposed. The tumor is then excised along with a margin of healthy tissue. Separately reportable frozen section may be performed to ensure that all margins are free of tumor cells. Drains are placed as needed and the surgical wound is closed in layers. For tumors in the subcutaneous fat or connective tissue, use 23075 for a mass less than 3 cm and 23071 for a mass 3 cm or greater. For tumors that lie below the fascia, use 23076 for a mass less than 5 cm and 23073 for a mass 5 cm or greater. Subfascial soft tissue tumors include those within muscle tissue.

*14031 is not a valid code

 

[RachelA_80432]

Since report says mass was "excised down to the fascia" that would still just be in the subq area. Correct? The 23071. But he closed it with a advancement flap. 14301. Would that flap include 23071?

This is where I get confused because the
Path report states mass is "Ascessory breast tissue" which would be 19120 (i think) with a Complex Advancement Close of 14301. Would it be appropriate to code both if the flap includes an excision?

 

[Alicia]

CPT Assistant Archives state for 14301
Question: A surgeon performs complex closures of the large dead space left following mastectomy, which double the operating time in most cases as these are meticulous and complex closures. Is the complex closure separately reportable?

Answer: No, the elimination of dead space is inherent to a mastectomy procedure. This may require a complex repair (eg, 13100-13102, 13131-13133), which is not separately reported with mastectomy. If this complex repair is substantially greater than typically required, it may be appropriate to append modifier 22, Increased Procedural Services, to the mastectomy code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physical and mental effort required). Lastly, if more than complex repair is performed, such as tissue transfer or
rearrangement (eg, V-Y plasty [14301]), then it may be appropriate to separately report the additional work with the appropriate code.

 

[RachelA_80432]

Sorry, I'm more confused now. I wasn't asking about a mastectomy or dead space.

I was asking about a fatty mass excision in the armpit that pathology said was breast tissue. And wanted to to know if 19120 could be coded with a 14301 for a complex close. Or if 14301 would be the more appropriate code since it includes an excision.