Overview of CPT Code 19160: Excision of breast lesion
CPT Code 19160 refers to the surgical excision of a breast lesion, which is a procedure performed to remove abnormal tissue from the breast. This procedure is often indicated for lesions that are suspicious for malignancy or causing symptoms.
When CPT Code 19160 is Used?
This procedure is typically indicated in several clinical scenarios.
- Presence of a palpable breast mass that requires evaluation.
- Suspicious findings on imaging studies such as mammograms.
- Lesions that are symptomatic, causing pain or discomfort.
- Biopsy results indicating atypical or malignant cells.
Symptoms Indicating This Procedure
Patients may report various symptoms that lead to the consideration of this procedure.
- A noticeable lump or mass in the breast.
- Changes in breast shape or size.
- Nipple discharge that is bloody or unusual.
- Pain or tenderness in the breast area.
Causes and Risk Factors
Several factors can contribute to the development of breast lesions.
- Family history of breast cancer.
- Genetic mutations such as BRCA1 or BRCA2.
- Previous breast biopsies or surgeries.
- Hormonal factors, including hormone replacement therapy.
Diagnostic Tests Before Procedure
Prior to the excision, several diagnostic tests may be performed.
- 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 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.
- Post-operative care instructions are provided.
Preparation for the Procedure
Patients should follow specific guidelines to prepare for the excision.
- 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 comfortable clothing and avoid jewelry on the day of the procedure.
Recovery and Aftercare
Post-operative recovery is crucial for healing.
- Rest for the first 24 hours after the procedure.
- Keep the surgical site clean and dry.
- Follow-up for suture removal as directed by the physician.
- Manage pain with prescribed medications or over-the-counter pain relievers.
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.
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Post-Procedure Follow-Up
Follow-up care is essential for monitoring recovery.
- Schedule a follow-up appointment within one to two weeks post-surgery.
- Monitor for any signs of infection or complications.
- Discuss pathology results and further management if necessary.
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.
Home Care Tips
Patients can take steps to aid their recovery at home.
- Keep the incision site clean and dry.
- Avoid strenuous activities for a few weeks.
- Monitor for any unusual symptoms and report them to your doctor.
- Follow a balanced diet to support healing.
Patient Education & Prevention
Education is key to preventing future issues.
- Regular breast self-exams to detect changes early.
- Routine 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: 19160
Category: Surgery
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 depending on facility and complexity.
- Most insurance plans cover the procedure if deemed medically necessary.
- Out-of-pocket costs may apply depending on the insurance plan.
Related CPT Codes
- 19161 - Breast Biopsy, Needle, Percutaneous
- 19162 - Breast Biopsy, Needle, Percutaneous
- 19200 - Excision of Breast Lesion
- 19240 - Injection of breast lesion
References and Sources
Frequently Asked Questions (FAQs)
What is the purpose of the excision?
The excision is performed to remove abnormal tissue and assess it for cancer.
How long does the procedure take?
The procedure typically takes about 30 minutes to an hour.
Will I need anesthesia?
Yes, local or general anesthesia will be used depending on the case.
What is the recovery time?
Most patients can return to normal activities within a week.
Are there any scars after the procedure?
Some scarring is possible, but it usually fades over time.
