Modern breast surgery: What you should know
In this Article
- Counseling patients on CPM
- Oncoplastic lumpectomy approach
- How to manage the lymph nodes
Expanded treatment options for breast cancer
Advancements in breast surgery, better imaging, and targeted therapies are changing the paradigm of breast cancer treatment.
Image-guided biopsy is key in decision making
When an abnormality is found in the breast, surgical excision of an undiagnosed breast lesion is no longer considered an appropriate first step. Use of image-guided biopsy or minimally invasive core needle biopsy allows for accurate diagnosis of a breast lesion while avoiding a potentially breast deforming and expensive surgical operation. It is always better to go into the operating room (OR) with a diagnosis and do the right operation the first time.
A core needle biopsy, results of which demonstrate a benign lesion, helps avoid breast surgery in women who do not need it. If cancer is diagnosed on biopsy, the extent of disease can be better evaluated and decision making can be more informed, with a multidisciplinary approach used to consider the various options, including genetic counseling, plastic surgery consultation, or neoadjuvant therapy. Some lesions, such as those too close to the skin, chest wall, or an implant, may not be amenable to core needle biopsy and therefore require surgical excision for diagnosis.
Benefits of a multidisciplinary tumor conference
It is important for a multidisciplinary group of cancer specialists to review a patient’s case and discuss the ideal treatment plan prior to surgery. Some breast cancer subtypes (such as human epidermal growth factor receptor 2 [HER2]–overamplified breast cancer and many triple-negative breast cancers) are very sensitive to chemotherapy, and patients with these tumor types may benefit from receiving neoadjuvant chemotherapy prior to surgery. New types of chemotherapy may allow up to 60% of some breast cancers to diminish almost completely, with subsequent improved cosmetic results of breast surgery.4 It may also allow time for genetic counseling and testing prior to surgery. (See “How to code for a multidisciplinary tumor conference” for appropriate coding procedure.)
How to code for a multidisciplinary tumor conference
Melanie Witt, RN, MA
There are two coding choices for team conferences involving physician participation. If the patient and/or family is present, the CPT instruction is to bill a problem E/M service code (99201-99215) based on the time spent during this coordination of care/counseling. Documentation would include details about the conference decisions and implications for care, rather than history or examination.
If the patient is not present, report 99367 (Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician), but note that this code was developed under the assumption that the conference would be performed in a facility setting. Diagnostic coding would be breast cancer.
Ms. Witt is an independent coding and documentation consultant and former program manager, department of coding and nomenclature, American Congress of Obstetricians and Gynecologists.
The author reports no financial relationships relevant to this article.
This is an excerpt from a companion coding resource for breast cancer–related procedures by Ms. Witt. To read the companion article, “Coding for breast cancer–related procedures: A how-to guide,” in its entirety, click here.
