This change is consistent with
Version 1.2017 of the National
Comprehensive Cancer Network
Clinical Practice Guidelines
in Oncology for Breast Cancer
Risk Reduction: “
Nipple-sparing mastectomy is a total
mastectomy with preservation
of the nipple/areola and breast
skin. Efforts should be made
to minimize the amount of
residual breast tissue.” 3
The distinction between a
simple, complete mastectomy
and subcutaneous mastectomy is
similar to the biopsy/lumpectomy
distinction, which also led to
coding confusion a decade ago
due to incorrect coding advice.
Today, it is well understood
that these procedures are not
reported based on the volume
of tissue removed, but rather on
the intent to achieve negative
margins. For example, excision
of a 4 cm fibroadenoma in a
19-year-old patient is reported
with code 19120, Excision of cyst,
fibroadenoma, or other benign or
malignant tumor, aberrant breast
tissue, duct lesion, nipple or areolar
lesion (except 19300), open, male or
female, 1 or more lesions (breast
biopsy). In contrast, excision of
an 8 mm carcinoma via a 2. 5 cm
surgical specimen is reported
with code 19301, Mastectomy,
partial (eg, lumpectomy, tylectomy,
To summarize, report
code 19303 for a skin-sparing
or nipple-sparing mastectomy
for diagnosed carcinoma or for
patients who are at high risk
for carcinoma, regardless of
the amount of skin removed or
whether the nipple is preserved.
The “Coding and practice
management corner” column
in the September 2014 Bulletin
provides additional guidance
on breast surgery coding. 4 ♦
Accurate coding is the responsibility
of the provider. This summary is
intended only to serve as a resource
to assist in the billing process.
1. American Medical Association.
Surgery: Integumentary system. CPT
Assistant Newsletter. 2007; 17( 12): 7.
2. American Medical Association.
Coding brief: Coding for breast
surgery. CPT Assistant Newsletter.
2015; 25( 3): 5, 11.
3. National Comprehensive Cancer
Network. Clinical Practice Guidelines
in Oncology for Breast Cancer Risk
Reduction, Version 1.2017. Password
protected. Available at: nccn.org/
breast_risk.pdf. Accessed January 24,
4. Barney L, Savarise MT, Whitacre E.
Coding and practice management
corner: Frequently asked questions
about coding for breast surgery.
Bull Am Coll Surg. 2014; 99( 9): 52-54.
Available at: bulletin.facs.org/2014/09/
February 14, 2017.
CODING AND PRACTICE MANAGEMENT CORNER
To summarize, report code 19303 for a skin-sparing or nipple-sparing mastectomy for diagnosed carcinoma or for patients
who are at high risk for carcinoma, regardless of the amount
of skin removed or whether the nipple is preserved.