How To Use CPT Code 19120

CPT 19120 refers to the excision of cysts, fibroadenomas, or other benign or malignant tumors from breast tissue. This surgical procedure is performed on both males and females and involves the open removal of one or more lesions that may be suspicious or abnormal. The procedure is crucial for diagnosing and treating various breast conditions, ensuring that any potentially harmful tissue is effectively removed and evaluated.

1. What is CPT code 19120?

CPT code 19120 represents a surgical procedure for the excision of one or more lesions from the breast, which may include cysts, fibroadenomas, or other types of tumors. This code is applicable to both male and female patients and is utilized when there is a need to remove abnormal breast tissue through an open surgical approach. The purpose of this procedure is to eliminate potentially harmful tissue, allowing for pathological evaluation to determine whether the lesions are benign or malignant. The excision can vary in extent based on the nature of the lesions and the associated risks, making it a critical intervention in breast health management.

2. Qualifying Circumstances

This CPT code can be used under specific circumstances where there is a clinical indication for the excision of breast lesions. It is appropriate when a patient presents with one or more suspicious lesions that require surgical intervention. The procedure is typically performed when imaging studies, such as mammograms or ultrasounds, suggest the presence of abnormal tissue that may pose a risk of malignancy. However, it is not appropriate for lesions that do not warrant surgical excision or for cases where less invasive treatments are sufficient. Additionally, if the procedure involves excising a solitary lactiferous duct or a papilloma, different codes should be used, such as 19110.

3. When To Use CPT 19120

CPT code 19120 is used when a provider performs an open excision of one or more breast lesions during a single surgical session. It is important to note that if lesions are excised from both breasts, modifier 50 should be applied to indicate a bilateral procedure. In cases where different procedures are performed on each breast, the appropriate modifiers (LT for left and RT for right) should be used to specify the location of each procedure. Additionally, modifier 59 may be necessary for distinct procedural services performed on different breasts. Providers should verify with payers to ensure proper coding and avoid claim denials.

4. Official Description of CPT 19120

Official Descriptor: Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions.

5. Clinical Application

The clinical application of CPT code 19120 is significant in the management of breast health. This procedure is essential for the removal of abnormal growths that may indicate underlying health issues, including cancer. By excising these lesions, healthcare providers can obtain tissue samples for pathological evaluation, which is crucial for determining the nature of the lesions and guiding further treatment. The procedure not only addresses immediate concerns regarding breast health but also plays a vital role in preventive care by identifying and managing potential malignancies early.

5.1 Provider Responsibilities

During the procedure, the provider is responsible for several critical actions. Initially, the patient is prepped and anesthetized, either locally or generally, depending on the extent of the excision. The provider then makes an incision over the lesion to access the abnormal tissue. This involves dissecting through the skin, fascia, and muscle to reach the lesion. Once the lesion is identified, the provider excises it carefully, ensuring that surrounding healthy tissue is preserved as much as possible. After excision, the provider controls any bleeding using electrocautery and closes the incision in layers to promote optimal healing. If multiple lesions are present, the provider may excise additional lesions during the same session. A drainage catheter may be placed to facilitate healing, depending on the extent of the surgery.

5.2 Unique Challenges

One of the unique challenges associated with this procedure is the need for precise excision to ensure that all abnormal tissue is removed while minimizing damage to surrounding healthy tissue. This is particularly important in cases of malignant tumors, where a wider margin may be necessary to ensure complete removal. Additionally, the provider must be vigilant in controlling bleeding and managing any complications that may arise during the procedure. The psychological impact on patients, who may be anxious about the possibility of cancer, also presents a challenge that providers must address through effective communication and support.

5.3 Pre-Procedure Preparations

Before the procedure, the provider must conduct a thorough evaluation of the patient, which may include imaging studies such as mammograms or ultrasounds to assess the nature and location of the lesions. A comprehensive medical history and physical examination are essential to determine the appropriate surgical approach and to identify any potential risks. The provider should also discuss the procedure with the patient, including the risks, benefits, and expected outcomes, to ensure informed consent is obtained.

5.4 Post-Procedure Considerations

After the procedure, the patient requires careful monitoring to assess for any complications, such as infection or excessive bleeding. The provider will typically provide instructions for wound care and may schedule follow-up appointments to evaluate healing and discuss pathology results. If a drainage catheter was placed, the provider will monitor its output and determine when it can be safely removed. Ongoing support and education about signs of complications and the importance of follow-up care are crucial for the patient’s recovery.

6. Relevant Terminology

Aberrant: Refers to something that is unusual or abnormal in nature or structure.

Areola: The pigmented area surrounding the nipple, which can also refer to similar areas of pigmentation around other skin lesions.

Benign: A term used to describe a condition that is not malignant, meaning it is generally not life-threatening and may not require aggressive treatment.

Cyst: An abnormal, closed sac-like structure that can contain fluid, gas, or semi-solid material, distinct from surrounding tissues by its own membranous lining.

Fibroadenoma of breast: A type of solid, noncancerous tumor in the breast that is typically painless and does not increase the risk of breast cancer.

Malignant: Describes a tumor that is cancerous, capable of spreading to other parts of the body, and potentially life-threatening if not treated.

Open procedure: A surgical technique that involves making a large incision to allow direct visualization and access to the target anatomy.

7. Clinical Examples

1. A 45-year-old female presents with a palpable lump in her right breast that has been increasing in size. Imaging reveals a suspicious mass, prompting the provider to perform an excision.

2. A male patient discovers a firm, movable mass in his breast during a self-examination. Following imaging studies, the provider recommends excision to rule out malignancy.

3. A 30-year-old woman with a history of fibroadenomas undergoes excision of multiple lesions in her left breast due to changes in size and tenderness.

4. A patient presents with a painful cyst in the right breast that has not responded to conservative treatment. The provider decides to excise the cyst for relief and further evaluation.

5. A 50-year-old female with a family history of breast cancer has a suspicious lesion identified on a mammogram. The provider performs an excision to obtain tissue for biopsy.

6. A male patient with gynecomastia presents with a large fibroadenoma. The provider performs an excision to alleviate discomfort and assess the lesion.

7. A 60-year-old woman has a lesion near her nipple that has changed in appearance. The provider excises the lesion to determine if it is malignant.

8. A patient with a history of breast cancer presents with a new lesion. The provider performs an excision to evaluate for recurrence.

9. A 35-year-old woman with a painful breast cyst undergoes excision after imaging confirms the cyst’s presence and size.

10. A patient presents with multiple lesions in both breasts. The provider performs an excision on both sides, documenting the procedure with appropriate modifiers for bilateral excision.