I need help coding a surgery. Is the inferior dermal pedicle flap billed out separately from the mastectomy or is it included? If it can be billed, what CPT code would I use? Please help coding this surgery. I have posted part of the operative report. Thanking you in advance!
The inferior dermal pedicle flap was then drawn out. The patient was
injected in the subdermal injection on the right breast with radioactive sulfur
colloid. Deepithelialization was carried out of the inferior dermal pedicle
flap. The reduction-type pattern incision was then made with the Megadyne
PlasmaBlade and the inferior dermal pedicle flap was fashioned contiguous with
the inframammary fold. Flaps were then formed superiorly, medially, inferior to
the inframammary fold, and lateral to latissimus dorsi muscle. Dissection was
carried down to the chest wall. The breast was removed from the chest wall,
medial to lateral, inclusive of the pectoralis fascia. The breast was oriented
with silk suture, short superior margin and long lateral. Attention was turned
to the right axilla. Utilizing the Neoprobe, the significant radioactive node
was identified. This was clamped with an Allis clamp and excised. Faxitron
documented the presence of the clip of the node that had been previously
biopsied. This was sent for frozen section. It had not been down-staged; one
node was positive, one node was negative. Additional tissue was taken from the
axilla. Clinically enlarged nodes were again clamped with an Allis clamp. This
was excised and sent for permanent section. Individual bleeders were
Ligaclipped. The area was irrigated with normal saline solution. Intercostal
brachial long thoracic and thoracodorsal nerves were identified and preserved.
The area was injected with 30 mL of Exparel; 20 mL of Exparel was diluted with
40 mL of normal saline. Attention was turned to the left breast where a mirror
image incision was made. The inferior dermal pedicle flap was deepithelialized
and fashioned contiguous with the inframammary fold. The reduction type pattern
was then made with the inferior dermal pedicle flap. Flaps were then formed
superiorly, medially, inferior to the inframammary fold, and lateral to
latissimus dorsi muscle. Dissection was carried down to the chest wall. The
breast was removed from the chest wall, medial to lateral, inclusive of the
pectoralis fascia. The breast was oriented with silk suture, short superior
margin and long lateral. Again, individual bleeders were Ligaclipped. The area
was irrigated with normal saline solution. The inferior dermal pedicle flap
was then attached to the chest wall utilizing interrupted 3-0 PDS. A #19 Blake
drain was brought out through a separate stab incision and secured in place with
2-0 silk. Both incisions were then closed utilizing interrupted 3-0 PDS and
running subcuticular sutures of 4-0 Monocryl. Dermabond was placed, Adaptic, 4
x 4, ABD, front closure bra and a 6-inch Ace was used for moderate pressure.