How To Use CPT Code 19303

CPT 19303 refers to a simple, complete mastectomy procedure, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 19303?

CPT 19303 is a medical billing code used to describe a simple, complete mastectomy procedure. This procedure involves the removal of the entire breast, nipples, and skin surrounding the nipple-areolar complex, while leaving the pectoralis major and minor muscles and axillary nodes in place.

2. 19303 CPT code description

The official description of CPT code 19303 is: “Mastectomy, simple, complete.”

3. Procedure

The 19303 CPT code procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an elliptical incision over the nipple-areola complex and dissects down through the subcutaneous tissue, coagulating as they go.
3. Counter-traction is applied to the breast, and an assistant lifts a flap under tension perpendicular to the chest wall.
4. Using diathermy, the provider dissects the breast tissue away from the chest wall in all directions down to the pectoralis major and latissimus dorsi muscles, coagulating vessels as they go.
5. The breast tissue is removed.
6. A separate stab incision is made, and a suction drain is placed to drain out excess fluid.
7. The incision is closed without tension and the wound is dressed.

4. Qualifying circumstances

Patients eligible to receive CPT code 19303 services are those who require a simple, complete mastectomy due to medical conditions such as breast cancer, prophylactic mastectomy for high-risk patients, or other conditions where the removal of the entire breast is deemed necessary by the healthcare provider. The decision to perform a simple mastectomy is based on the patient’s medical history, physical examination, and diagnostic tests, as well as the provider’s clinical judgment.

5. When to use CPT code 19303

It is appropriate to bill the 19303 CPT code when a simple, complete mastectomy is performed on a patient who meets the qualifying circumstances mentioned above. The code should be used to accurately represent the specific procedure performed and to ensure proper reimbursement for the services provided.

6. Documentation requirements

To support a claim for CPT 19303, the following information should be documented:

• Patient’s medical history and physical examination findings
• Diagnostic tests and their results
• Indication for the mastectomy procedure
• Detailed description of the procedure performed, including the steps taken and any complications encountered
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 19303, it is essential to follow the appropriate billing guidelines and rules. These may include the use of modifiers, such as modifier 50 for bilateral procedures or modifier 59 for distinct procedural services. Additionally, it is crucial to ensure that documentation supports the use of any modifiers and accurately reflects the services provided. It is also important to be aware of any payer-specific guidelines or requirements that may apply to the billing of CPT code 19303.

8. Historical information

CPT 19303 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Similar codes to CPT 19303

Five similar codes to CPT 19303 and how they differentiate are:

• CPT 19305: Radical mastectomy including excision of pectoral muscles and axillary lymph nodes.
• CPT 19306: Radical mastectomy with excision of pectoral muscles, axillary lymph nodes, and internal mammary lymph nodes (Urban type operation).
• CPT 19307: Modified radical mastectomy including excision of axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle.
• CPT 19340: Immediate or delayed insertion of implant following mastectomy.
• CPT 19342: Delayed insertion of breast prosthesis following mastectomy.

10. Examples

Here are 10 detailed examples of CPT code 19303 procedures:

1. A 45-year-old female with invasive ductal carcinoma undergoing a simple mastectomy.
2. A 50-year-old female with a strong family history of breast cancer undergoing a prophylactic simple mastectomy.
3. A 55-year-old female with recurrent breast cancer after previous lumpectomy undergoing a simple mastectomy.
4. A 60-year-old female with ductal carcinoma in situ (DCIS) undergoing a simple mastectomy.
5. A 65-year-old female with multicentric breast cancer undergoing a simple mastectomy.
6. A 70-year-old female with a large breast tumor not amenable to breast-conserving surgery undergoing a simple mastectomy.
7. A 75-year-old female with a history of radiation therapy to the chest undergoing a simple mastectomy for a new breast cancer diagnosis.
8. A 40-year-old female with a BRCA gene mutation undergoing a prophylactic simple mastectomy.
9. A 48-year-old female with lobular carcinoma in situ (LCIS) undergoing a simple mastectomy.
10. A 52-year-old female with a history of atypical ductal hyperplasia (ADH) and a new breast cancer diagnosis undergoing a simple mastectomy.