Overview of CPT Code 19125: Excision of breast lesion
CPT Code 19125 refers to the surgical excision of a breast lesion, which may include tumors or abnormal growths. This procedure is performed to remove suspicious or problematic tissue for diagnostic or therapeutic purposes.
When CPT Code 19125 is Used?
This procedure is indicated in various clinical scenarios.
- Presence of a palpable breast mass that requires evaluation.
- Suspicious findings on imaging studies such as mammograms.
- Biopsy results indicating atypical or malignant cells.
- Patient preference for removal of a benign lesion.
Symptoms Indicating This Procedure
Patients may report several symptoms that lead to the consideration of this procedure.
- A lump or mass in the breast that can be felt.
- Changes in breast shape or size.
- Nipple discharge that is bloody or clear.
- Skin changes over the breast, such as dimpling or redness.
Causes and Risk Factors
Several factors may contribute to the development of breast lesions.
- Genetic predisposition, such as BRCA1 or BRCA2 mutations.
- Family history of breast cancer.
- Hormonal factors, including prolonged estrogen exposure.
- Previous breast biopsies or surgeries.
Diagnostic Tests Before Procedure
Several tests may be conducted to assess the breast lesion prior to excision.
- Mammography to visualize breast tissue.
- Ultrasound to assess the characteristics of the lesion.
- MRI for detailed imaging in 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 anesthesia is administered.
- An incision is made over the lesion to access the tissue.
- The lesion is carefully excised along with a margin of surrounding tissue.
- The incision is closed with sutures or adhesive strips.
- Specimen is sent for pathological examination.
Preparation for the Procedure
Patients should follow specific guidelines before the procedure.
- Avoid blood thinners and certain medications as advised by the physician.
- Do not eat or drink for a specified period before surgery.
- Arrange for transportation home post-procedure.
- Discuss any allergies or medical conditions with the healthcare provider.
Recovery and Aftercare
Post-procedure recovery involves several considerations.
- Rest for the first 24 hours after the procedure.
- 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.
Possible Complications
While generally safe, this procedure carries some risks.
- Infection at the surgical site.
- Bleeding or hematoma formation.
- Scarring or changes in breast appearance.
- Nerve damage leading to altered sensation.
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Post-Procedure Follow-Up
Follow-up care is essential for monitoring recovery.
- Initial follow-up within one week to assess healing.
- Pathology results review typically within 1-2 weeks.
- Further imaging or treatment based on pathology findings.
Alternative Treatments
Non-surgical options may be considered in certain cases.
- Observation for benign lesions without symptoms.
- Medications for hormonal therapy in specific conditions.
- Radiation therapy for certain types of breast cancer.
Home Care Tips
Patients can follow these tips for better recovery.
- Avoid strenuous activities for a few weeks.
- Monitor the incision site for signs of infection.
- Keep follow-up appointments as scheduled.
- Use ice packs to reduce swelling if needed.
Patient Education & Prevention
Education is key to prevention and early detection.
- Regular breast self-exams to detect changes early.
- Routine mammograms as recommended based on age and risk.
- Healthy lifestyle choices to reduce breast cancer risk.
- Genetic counseling for those with a family history.
Billing and Coding Information
CPT Code: 19125
Category: Surgical Procedures
Common Modifiers:
- 50 (bilateral procedure)
- RT (right side)
- LT (left side)
Average Cost and Insurance Coverage
Costs can vary based on several factors.
- 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 insurance plan and deductible.
Related CPT Codes
- 19120 - Excision of Breast Lesion
- 19121 - Breast Biopsy, Needle, Percutaneous
- 19200 - Excision of Breast Lesion
- 19281 - Breast Biopsy, Needle, Percutaneous
References and Sources
Frequently Asked Questions (FAQs)
What is the purpose of the excision?
The excision is performed to remove a breast lesion for diagnosis or treatment.
Will I need anesthesia?
Yes, local or general anesthesia will be used to ensure comfort during the procedure.
How long is the recovery period?
Most patients can expect to recover within a few weeks, depending on individual healing.
Are there any restrictions after the procedure?
Yes, you should avoid heavy lifting and strenuous activities for a few weeks.
What happens if the lesion is cancerous?
If cancer is detected, further treatment options will be discussed with your healthcare provider.
