How To Use CPT Code 19307

CPT code 19307 describes a modified radical mastectomy procedure, which involves the removal of all breast tissue from the affected breast, along with the removal of axillary lymph nodes. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 19307?

CPT code 19307 is used to describe a modified radical mastectomy procedure. This surgical procedure involves the removal of all breast tissue from the affected breast, along with the removal of axillary lymph nodes from the armpit on the affected side of the body. The surgeon performs the procedure using an elliptical incision that starts on the inside of the breast, near the breastbone, and extends towards the armpit. The procedure may include the removal of both the nipple and areola, although it can also be performed using a skin and nipple-sparing method. The pectoralis minor muscle may or may not be removed, but the major pectoralis muscle of the chest under the breast is spared. Skin grafts or flaps may be used if necessary. The incision is closed with absorbable sutures or staples, which are typically removed 10-14 days after surgery.

2. Official Description

The official description of CPT code 19307 is: ‘Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle. Intraoperative placement of clip(s) is not separately reported. For immediate or delayed insertion of an implant, see 19340, 19342.’

3. Procedure

1. The surgeon makes an elliptical incision on the affected breast, starting from the inside near the breastbone and extending towards the armpit.
2. All breast tissue from the affected breast is removed, along with the axillary lymph nodes from the armpit on the affected side.
3. The surgeon may choose to remove both the nipple and areola, or perform a skin and nipple-sparing method.
4. If necessary, skin grafts or flaps may be used to reconstruct the breast.
5. The incision is closed using absorbable sutures or staples, which are typically removed 10-14 days after surgery.

4. Qualifying circumstances

CPT code 19307 is used for patients who require a modified radical mastectomy procedure. This procedure is typically performed on patients with breast cancer or other conditions that necessitate the removal of breast tissue and axillary lymph nodes. The decision to perform a modified radical mastectomy is based on the patient’s specific medical condition and the recommendation of their healthcare provider.

5. When to use CPT code 19307

CPT code 19307 should be used when a modified radical mastectomy procedure is performed, which involves the removal of all breast tissue from the affected breast and the removal of axillary lymph nodes. This code should not be used for other types of mastectomy procedures, such as simple mastectomy or radical mastectomy with excision of pectoral muscles and additional lymph nodes.

6. Documentation requirements

To support a claim for CPT code 19307, the following documentation is required:

• Patient’s diagnosis and the medical necessity for a modified radical mastectomy
• Description of the procedure performed, including the removal of breast tissue and axillary lymph nodes
• Details of any additional procedures performed, such as the removal of the nipple and areola or the use of skin grafts or flaps
• Date of the surgery and the duration of the procedure
• Method of closure used, such as absorbable sutures or staples
• Any complications or unexpected findings during the procedure
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT code 19307, ensure that the procedure performed meets the criteria for a modified radical mastectomy, including the removal of breast tissue and axillary lymph nodes. It is important to note that the placement of clips during the procedure should not be separately reported. If an implant is inserted immediately or at a later time, separate codes (19340, 19342) should be used. Modifier 50 should be added if the procedure is performed bilaterally. Modifier 59 should be used if a different procedure was performed on the other breast during the same session. Documentation must support the use of modifiers and any additional procedures performed.

8. Historical information

CPT code 19307 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Examples

1. A patient with breast cancer undergoes a modified radical mastectomy, including the removal of breast tissue and axillary lymph nodes.
2. A patient with a high-risk genetic mutation undergoes a prophylactic modified radical mastectomy to reduce their risk of developing breast cancer.
3. A patient with a large tumor in their breast undergoes a modified radical mastectomy to remove the tumor and surrounding tissue.
4. A patient with extensive lymph node involvement undergoes a modified radical mastectomy to remove the affected lymph nodes.
5. A patient with a recurrence of breast cancer undergoes a modified radical mastectomy after previous treatments were unsuccessful.
6. A patient with a locally advanced breast cancer undergoes a modified radical mastectomy as part of their multimodal treatment plan.
7. A patient with a large breast tumor undergoes a modified radical mastectomy to achieve complete tumor removal.
8. A patient with a history of breast cancer in one breast undergoes a contralateral prophylactic modified radical mastectomy to reduce their risk of developing cancer in the other breast.