19301

Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy

Code 19301 represents a partial mastectomy, which involves the surgical removal of a portion of the breast (e.g., lumpectomy, tylectomy, quadrantectomy, or segmentectomy) that contains a malignant tumor or suspicious lesion, along with an axillary lymphadenectomy. An axillary lymphadenectomy is the surgical removal of lymph nodes from the axilla (armpit). This procedure is typically performed for the treatment and staging of breast cancer, aiming to excise the primary tumor with adequate margins and assess the involvement of regional lymph nodes to determine the extent of the disease and guide subsequent therapeutic decisions.

Clinical Indications

  • Confirmed diagnosis of invasive breast carcinoma suitable for breast-conserving surgery.
  • Diagnosis of high-grade or extensive ductal carcinoma in situ (DCIS) with suspicion of microinvasion or requiring nodal staging.
  • To achieve clear surgical margins following a previous excisional biopsy that demonstrated malignancy.
  • Staging of breast cancer to determine the presence and extent of regional lymph node involvement.
  • Patients undergoing breast-conserving therapy (BCT) where axillary staging is indicated.

Procedure Steps

  1. Preoperative localization of the breast lesion using imaging guidance (e.g., wire, radioactive seed, or magnetic marker) as necessary.
  2. Administration of appropriate anesthesia (typically general anesthesia).
  3. Creation of an incision in the breast overlying the lesion or in an aesthetically favorable location.
  4. Excision of the primary tumor along with a margin of surrounding healthy breast tissue (partial mastectomy).
  5. Achieving meticulous hemostasis in the breast surgical bed.
  6. Closure of the breast incision in layers.
  7. Creation of a separate incision in the axilla (armpit).
  8. Dissection and removal of axillary lymph nodes, typically levels I and II, and potentially level III based on surgical findings and disease extent.
  9. Meticulous hemostasis in the axillary region.
  10. Placement of drains in the breast and/or axilla as clinically indicated.
  11. Closure of the axillary incision in layers.
  12. Specimen sent for pathological examination to confirm diagnosis, assess margins, and determine lymph node status.

Coding Guidelines

  • Code 19301 includes both the partial mastectomy and the axillary lymphadenectomy. It should not be reported in conjunction with codes for partial mastectomy alone (e.g., 19300) or separate axillary lymphadenectomy codes (e.g., 38740, 38745) when performed on the same side for the same cancer.
  • If a sentinel lymph node biopsy is performed and a full axillary lymphadenectomy is also performed, the sentinel lymph node biopsy is considered an inclusive component of the axillary lymphadenectomy and is generally not separately reported with 19301.
  • Separate codes may be reported for preoperative localization procedures (e.g., 19281-19288) or placement of fiducial markers (e.g., 19285-19288) when performed prior to or concurrently with the excision.
  • Pathology services (e.g., 88307, 88309) for the examination of excised tissue are reported separately by the pathologist.
  • Modifier 50 (Bilateral Procedure) may be appended if the procedure is performed on both breasts/axillae.
  • This procedure has a global surgical period, and postoperative care is typically included in the reimbursement.

Associated ICD-10 Codes