How To Use CPT Code 19301

CPT 19301 refers to a partial 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 19301?

CPT 19301 is a medical billing code used to describe a partial mastectomy procedure. This procedure involves the removal of a lesion, including surrounding margins, or a significant portion of the breast without removing the entire breast or lymph nodes. It is commonly performed to eradicate suspicious or cancerous lesions in the breast through an open and excisional process.

2. 19301 CPT code description

The official description of CPT code 19301 is: “Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)”.

3. Procedure

1. The provider incises the skin of the breast over a suspicious lump.
2. The lump or a significant portion of the breast, along with the margins, is excised.
3. Any additional lesions in the area are checked and also removed.
4. When all cancerous or suspicious tissues are eradicated, the provider places a drain.
5. The surgical wound is closed, and a dressing is applied.

4. Qualifying circumstances

Patients eligible to receive CPT code 19301 services are those with suspicious or cancerous lesions in the breast that require removal through an open and excisional process. This includes patients with a confirmed diagnosis of breast cancer or those with a high suspicion of malignancy based on imaging studies, physical examination, or biopsy results. The procedure is typically performed as a breast-conserving surgery for patients with early-stage breast cancer or those who are not candidates for a total mastectomy due to medical or personal reasons.

5. When to use CPT code 19301

It is appropriate to bill the 19301 CPT code when a partial mastectomy procedure is performed to remove a lesion, including surrounding margins, or a significant portion of the breast without removing the entire breast or lymph nodes. This code should be used when the procedure is performed as a breast-conserving surgery for patients with early-stage breast cancer or those who are not candidates for a total mastectomy due to medical or personal reasons.

6. Documentation requirements

To support a claim for CPT 19301, the following information needs to be documented:

• Patient’s medical history and physical examination findings.
• Imaging studies, biopsy results, or other diagnostic tests supporting the need for a partial mastectomy.
• Operative report detailing the procedure, including the incision, excision of the lesion or breast tissue, and closure of the surgical wound.
• Pathology report confirming the diagnosis and adequacy of the margins removed.
• Postoperative care plan and follow-up instructions.

7. Billing guidelines

When billing for CPT code 19301, it is essential to ensure that the documentation supports the need for a partial mastectomy and that the procedure was performed as described. If the surgeon removes a lesion plus a significant portion of the surrounding tissue, a partial mastectomy code may be reported instead of a lesion excision code, provided that the documentation shows the adequacy of the margins removed. This will increase revenue for the provider. To report the same procedure but with the excision of axillary lymph nodes, see CPT code 19302.

8. Historical information

CPT 19301 was added to the Current Procedural Terminology system on January 1, 2007. The code was changed on January 1, 2010, with the previous descriptor being “Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);”.

9. Similar codes to CPT 19301

Five similar codes to CPT 19301 and how they differentiate are:

1. CPT 19302: Includes the excision of axillary lymph nodes in addition to the partial mastectomy.
2. CPT 19303: Describes a total mastectomy procedure, which involves the removal of the entire breast.
3. CPT 19304: Refers to a subcutaneous mastectomy, where the breast tissue is removed, but the skin and nipple-areola complex are preserved.
4. CPT 19305: Involves a radical mastectomy, which includes the removal of the entire breast, pectoral muscles, and axillary lymph nodes.
5. CPT 19306: Describes an extended radical mastectomy, which is a more extensive procedure than a radical mastectomy and includes the removal of additional chest wall structures.

10. Examples

Here are 10 detailed examples of CPT code 19301 procedures:

1. A 45-year-old female with a 2 cm invasive ductal carcinoma in the upper outer quadrant of the left breast undergoes a lumpectomy with clear margins.
2. A 55-year-old male with a palpable mass in the right breast is diagnosed with invasive lobular carcinoma and undergoes a segmentectomy with negative margins.
3. A 38-year-old female with a history of atypical ductal hyperplasia has a suspicious lesion on mammography and undergoes a tylectomy with benign pathology results.
4. A 50-year-old female with a 1.5 cm invasive ductal carcinoma in the lower inner quadrant of the right breast undergoes a quadrantectomy with clear margins.
5. A 60-year-old female with a biopsy-proven ductal carcinoma in situ (DCIS) undergoes a lumpectomy with close margins, requiring re-excision to achieve negative margins.
6. A 48-year-old female with a palpable mass in the left breast is diagnosed with invasive ductal carcinoma and undergoes a segmentectomy with negative margins.
7. A 52-year-old female with a history of atypical lobular hyperplasia has a suspicious lesion on mammography and undergoes a tylectomy with benign pathology results.
8. A 57-year-old female with a 2.5 cm invasive lobular carcinoma in the upper inner quadrant of the left breast undergoes a quadrantectomy with clear margins.
9. A 62-year-old female with a biopsy-proven ductal carcinoma in situ (DCIS) undergoes a lumpectomy with close margins, requiring re-excision to achieve negative margins.
10. A 65-year-old female with a palpable mass in the right breast is diagnosed with invasive ductal carcinoma and undergoes a segmentectomy with negative margins.