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The CPT® Code 19294 refers to the preparation of the tumor cavity with the placement of a radiation therapy applicator specifically for intraoperative radiation therapy (IORT) that is performed concurrently with a partial mastectomy. This procedure is a critical component of breast conservation therapy (BCT), which aims to remove malignant breast tumors while preserving as much healthy tissue as possible. During IORT, a targeted dose of radiation is delivered directly to the tumor bed immediately after the tumor is excised. This approach is designed to eliminate any microscopic residual tumor cells that may remain in the area, thereby reducing the risk of local recurrence of breast cancer. The procedure involves careful preparation of the tumor cavity, which includes separating the remaining breast tissue from the underlying pectoralis muscle and the skin. A protective disc is then placed beneath the breast tissue to shield vital organs such as the heart, lungs, and ribs from radiation exposure. Following this preparation, a radiation applicator tube is inserted into the tumor bed to facilitate the delivery of the radiation dose. Once the IORT is completed, both the applicator tube and the protective disc are removed. It is important to note that CPT® Code 19294 is reported separately in addition to the code(s) for the primary procedure(s) performed, such as the partial mastectomy, ensuring accurate billing and documentation of the services rendered.
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The procedure associated with CPT® Code 19294 is indicated for patients undergoing breast conservation therapy (BCT) when a malignant breast tumor is present. The specific indications for performing intraoperative radiation therapy (IORT) concurrent with a partial mastectomy include:
The procedure for CPT® Code 19294 involves several critical steps to ensure the effective delivery of intraoperative radiation therapy (IORT) during a partial mastectomy. The steps are as follows:
After the completion of the procedure associated with CPT® Code 19294, patients may require specific post-procedure care to ensure proper recovery. This may include monitoring for any immediate complications related to the surgery or radiation therapy. Patients are typically advised to follow up with their healthcare provider for ongoing assessments and to discuss any further treatment options, such as adjuvant therapies. Additionally, patients may experience localized swelling or discomfort in the breast area, which should be managed according to the physician's recommendations. It is essential for patients to adhere to any prescribed follow-up appointments to monitor their recovery and overall health following the procedure.
Short Descr | PREPJ TUM CAV IORT PRTL MAST | Medium Descr | PREPJ TUMOR CAVITY IORT W/PARTIAL MASTECTOMY | Long Descr | Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 2 |
This is an add-on code that must be used in conjunction with one of these primary codes.
19301 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); | 19302 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy |
59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | LT | Left side (used to identify procedures performed on the left side of the body) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | RT | Right side (used to identify procedures performed on the right side of the body) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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2023-01-01 | Note | Short and medium descriptions changed. |
2018-01-01 | Added | Code Added. |