Overview of CPT Code 19100:'Excision of breast lesion'
CPT Code 19100 refers to the surgical excision of a breast lesion, which may include tumors or abnormal growths. This procedure is performed to remove potentially cancerous or benign lesions for diagnostic and therapeutic purposes.
When CPT Code 19100 is Used?
This procedure is indicated in various clinical scenarios.
- Presence of a palpable breast mass that requires evaluation.
- Suspicious imaging findings suggesting a lesion.
- Biopsy results indicating the need for further excision.
- Patient history of breast cancer with new lesions.
- Lesions causing discomfort or cosmetic concerns.
Symptoms Indicating This Procedure
Patients may report several symptoms that lead to the consideration of this procedure.
- A lump or mass in the breast.
- Changes in breast shape or size.
- Nipple discharge that is bloody or clear.
- Skin changes over the breast, such as dimpling or redness.
- Pain or tenderness in the breast area.
Causes and Risk Factors
Understanding the causes and risk factors can help in early detection.
- Family history of breast cancer.
- Genetic mutations such as BRCA1 or BRCA2.
- Previous history of breast lesions or cancer.
- Age, with increased risk in women over 50.
- Hormonal factors, including prolonged estrogen exposure.
Diagnostic Tests Before Procedure
Several tests may be conducted to assess the lesion before excision.
- Mammography to visualize breast tissue.
- Ultrasound to assess the characteristics of the lesion.
- MRI for detailed imaging of complex cases.
- Fine needle aspiration or core needle biopsy for histological evaluation.
Procedure Description
The excision procedure involves several key steps.
- Patient is positioned comfortably and prepped for surgery.
- Local anesthesia is administered to numb the area.
- An incision is made over the lesion to access the tissue.
- The lesion is carefully excised along with a margin of healthy tissue.
- The incision is closed with sutures or adhesive strips.
- Post-operative care instructions are provided.
Preparation for the Procedure
Proper preparation is essential for a successful procedure.
- Avoid blood thinners and certain medications as advised by the physician.
- Do not eat or drink for several hours before the procedure if sedation is planned.
- Arrange for transportation home post-procedure.
- Wear loose-fitting clothing for comfort after surgery.
Recovery and Aftercare
Recovery typically involves monitoring and care of the surgical site.
- Rest for the first 24 hours post-surgery.
- Keep the surgical site clean and dry.
- Follow-up for suture removal as directed.
- Manage pain with prescribed medications or over-the-counter pain relievers.
- Watch for signs of infection, such as increased redness or discharge.
Possible Complications
While generally safe, there are potential risks associated with the procedure.
- Infection at the surgical site.
- Excessive bleeding or hematoma formation.
- Scarring or changes in breast appearance.
- Nerve damage leading to altered sensation.
- Recurrence of the lesion.
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Post-Procedure Follow-Up
Follow-up care is crucial for monitoring recovery.
- Schedule a follow-up appointment within 1-2 weeks post-surgery.
- Review pathology results to determine further treatment if necessary.
- Monitor for any complications or concerns during recovery.
Alternative Treatments
In some cases, non-surgical options may be considered.
- Observation for benign lesions without symptoms.
- Medication for hormonal imbalances.
- Radiation therapy for certain types of breast lesions.
- Cryoablation or laser therapy for localized treatment.
Home Care Tips
Patients can take steps to aid their recovery at home.
- Keep the surgical area clean and dry.
- Avoid strenuous activities for a few weeks.
- Use ice packs to reduce swelling if needed.
- Follow dietary recommendations for healing.
- Stay hydrated and maintain a balanced diet.
Patient Education & Prevention
Education is key to prevention and early detection.
- Regular breast self-exams to detect changes early.
- Routine mammograms as recommended by healthcare providers.
- Discuss family history and risk factors with a doctor.
- Maintain a healthy lifestyle to reduce cancer risk.
Billing and Coding Information
CPT Code: 19100
Category: Surgical Procedures
Common Modifiers:
- 50 - Bilateral procedure
- RT - Right side
- LT - Left side
Average Cost and Insurance Coverage
Costs can vary based on location and insurance.
- Average cost ranges from $2,000 to $5,000.
- Insurance may cover the procedure if deemed medically necessary.
- Out-of-pocket costs depend on the patient's insurance plan.
Related CPT Codes
- 19101 - Biopsy of breast, percutaneous, needle
- 19102 - Excision of Breast Lesion
- 19103 - Excision of breast lesion, malignant
- 19105 - Breast Biopsy, Needle
References and Sources
Frequently Asked Questions (FAQs)
What is the purpose of the excision?
The excision is performed to remove abnormal tissue for diagnosis or treatment.
Will I need anesthesia?
Yes, local or general anesthesia will be used depending on the procedure.
How long is the recovery period?
Most patients recover within a few weeks, but follow your doctor's advice.
Are there any scars after the procedure?
Some scarring may occur, but it typically fades over time.
When will I know the results of the biopsy?
Results are usually available within a week after the procedure.
