Overview of CPT Code 19103: Excision of breast lesion, malignant
CPT Code 19103 refers to the surgical excision of a malignant breast lesion. This procedure is performed to remove cancerous tissue from the breast, ensuring clear margins to prevent recurrence.
When CPT Code 19103 is Used?
This code is applicable in various clinical scenarios.
- Diagnosis of breast cancer confirmed by biopsy.
- Presence of a palpable malignant breast mass.
- Suspicious imaging findings indicating malignancy.
- Patient preference for surgical intervention after diagnosis.
Symptoms Indicating This Procedure
Patients may report several symptoms that lead to the need for 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 puckering.
Causes and Risk Factors
Understanding the causes and risk factors can help in early detection.
- Family history of breast cancer.
- Genetic mutations (e.g., BRCA1, BRCA2).
- Age over 50.
- Previous breast biopsies showing atypical hyperplasia.
Diagnostic Tests Before Procedure
Several tests are conducted to confirm the diagnosis and plan the procedure.
- Mammography to identify suspicious lesions.
- Ultrasound to evaluate the characteristics of the mass.
- MRI for detailed imaging of breast tissue.
- Biopsy to confirm malignancy.
Procedure Description
The excision procedure involves several key steps.
- Patient is positioned comfortably and anesthetized.
- An incision is made over the lesion.
- The malignant tissue is carefully excised along with a margin of healthy tissue.
- The incision is closed with sutures or staples.
- Specimen is sent for pathological examination.
Preparation for the Procedure
Proper preparation is essential for a successful procedure.
- Avoid blood thinners for a week prior to surgery.
- Do not eat or drink after midnight before the procedure.
- Arrange for transportation home post-surgery.
- Discuss any medications with your healthcare provider.
Recovery and Aftercare
Post-operative care is crucial for healing.
- Rest for the first 24 hours after surgery.
- Keep the surgical site clean and dry.
- Follow-up appointment within a week to check healing.
- Pain management with prescribed medications as needed.
Possible Complications
While complications are rare, they can occur.
- Infection at the surgical site.
- Excessive bleeding.
- Scarring.
- Recurrence of breast cancer.
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Post-Procedure Follow-Up
Regular follow-up is important for monitoring recovery.
- Initial follow-up within 1 week post-surgery.
- Further follow-ups every 3-6 months for the first 2 years.
- Annual mammograms as recommended by the physician.
Alternative Treatments
There are non-surgical options available for managing breast lesions.
- Radiation therapy for localized cancer.
- Chemotherapy for systemic treatment.
- Hormonal therapy for hormone-sensitive tumors.
Home Care Tips
Patients can take steps at home to aid recovery.
- Apply ice packs to reduce swelling.
- Avoid strenuous activities for at least 2 weeks.
- Monitor for signs of infection, such as increased redness or discharge.
- Keep follow-up appointments as scheduled.
Patient Education & Prevention
Education is key to prevention and early detection.
- Regular breast self-exams to detect changes early.
- Annual mammograms as recommended based on age and risk factors.
- Healthy lifestyle choices, including diet and exercise.
- Genetic counseling for those with a family history of breast cancer.
Billing and Coding Information
CPT Code: 19103
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 $3,000 to $10,000.
- Insurance typically covers the procedure if deemed medically necessary.
- Out-of-pocket costs depend on the insurance plan.
Related CPT Codes
- 19101 - Biopsy of breast, percutaneous, needle
- 19102 - Excision of Breast Lesion
- 19200 - Excision of Breast Lesion
- 19281 - Breast Biopsy, Needle, Percutaneous
- 19301 - Breast Reconstruction, Unilateral
References and Sources
Frequently Asked Questions (FAQs)
What is the purpose of the excision?
The excision aims to remove cancerous tissue and prevent its spread.
How long is the recovery period?
Most patients recover within 1 to 2 weeks.
Will I have a scar after the procedure?
Yes, there will be a scar, but it typically fades over time.
Is this procedure painful?
Some discomfort is expected, but pain can be managed with medication.
