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AHA Coding Clinic® for HCPCS - 2021 Issue 2; Ask the Editor

Oncoplastic reconstruction

A patient with right breast cancer and bilateral breast papillomas presented for bilateral lumpectomies with oncoplastic reconstruction. Following the removal of tissue via lumpectomy, reconstruction was started on the left breast. An inferior pedicle and flaps of skin and subcutaneous tissue were designed, consistent with a wise pattern, to fill the defect and reduce breast volume on the left. Flaps of the superior medial and superior lateral skin and subcutaneous tissue were also made. The inferior pedicle remained attached to the nipple areola complex. Additional tissue between the flaps, pedicle and chest wall was excised. The tissues of the flaps superficial to the inferior pedicle and nipple areola complex were sutured in the deep parenchyma. The remainder of the skin incisions were provisionally stapled.Attention was then turned to the right breast. Following the lumpectomy, a small amount of additional tissue was resected around the lateral aspect of the superiomedial pedicle. The medial and lateral pillars of breast parenchyma were undermined consistent with a vertical reduction pattern and the pillars were brought together and sutured. There was lower pole skin redundancy which was converted into a J shape and additional skin and subcutaneous fat was resected. Both sides were closed.In this case, oncoplastic reconstruction is similar to a breast reduction procedure. However, bilateral lumpectomies were also performed and there is an NCCI edit that prevents reporting CPT code 19318, Breast reduction, with code 19301, Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);. What is the correct code for the oncoplastic reconstruction? ...

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