Overview of CPT Code 19200: Excision of Breast Lesion
CPT Code 19200 refers to the surgical excision of a breast lesion, which may include benign or malignant tumors. This procedure is performed to remove abnormal tissue from the breast for diagnostic or therapeutic purposes.
When CPT Code 19200 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-proven breast cancer requiring excision.
- Removal of benign 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.
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 breast lesions or biopsies.
- Age, with increased risk in women over 50.
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 anesthesia is administered.
- 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 comfortable clothing and avoid jewelry on the day of the procedure.
Recovery and Aftercare
Recovery time varies, and proper aftercare is crucial.
- Rest for the first 24 hours post-surgery.
- Keep the surgical site clean and dry.
- Follow-up appointments to monitor healing.
- Pain management with prescribed medications as needed.
Possible Complications
While complications are rare, they can occur.
- 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 is important to ensure proper healing.
- Initial follow-up within one week to check the incision.
- Further follow-ups as needed based on pathology results.
- Regular breast examinations as part of ongoing care.
Alternative Treatments
There are non-surgical options available for some conditions.
- Monitoring with regular imaging for benign lesions.
- Medications for hormonal therapy in certain breast conditions.
- Radiation therapy for localized cancer treatment.
Home Care Tips
Patients can take steps to aid recovery at home.
- Keep the surgical area clean and dry.
- Avoid strenuous activities for a few weeks.
- Monitor for signs of infection such as increased redness or discharge.
- Follow dietary recommendations for healing.
Patient Education & Prevention
Education is key to prevention and early detection.
- Regular breast self-exams to detect changes early.
- Annual mammograms as recommended by healthcare providers.
- Healthy lifestyle choices to reduce breast cancer risk.
- Genetic counseling for those with a family history of breast cancer.
Billing and Coding Information
CPT Code: 19200
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
- 19120 - Excision of Breast Lesion
- 19125 - 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 for diagnosis or treatment.
Will I need anesthesia?
Yes, local or general anesthesia is typically used during the procedure.
How long is the recovery period?
Most patients recover within a few weeks, but it varies by individual.
