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Breast Cancer (Expert Forum)
Surgery tomorrow - Last minute questions
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Surgery tomorrow - Last minute questions
by alleycallie, Oct 07, 2003 12:00AM
First of all thanks to all who have responded in the past couple of weeks to questions I have posted!
After my last path report came, my surgeon scheduled me for what I thought was a surgical biopsy, taking more tissue and trying to get enough for good margins. Yesterday when I had my last appt. prior to my surgery tomorrow, the pre-op form said "lumpectomy." Further, the nurse said not to freak out at the hospital because for coding purposes, the hospital forms would say partial mastectomy. What in the world AM I having??? Are all three the same in the eyes of the insurance world?
Is this just the shell games hospitals play with insurance companies? Is what it is called going to affect my insurance? Since I will be paying for 20% of this, are the costs different depending on what name it is given?
Also, my surgeon said he felt confident that he could tell where the stereotactic procedure was done without having to "use a wire." He mentioned that he could do a floroscope.....and he had been palpating the area to know where the site was. They did insert a metal piece during the first biopsy. Isn't there some better way to know precisely where the site is? Do surgery suites not have the radiology equipment? And without it, how would he place a wire?
Finally, I just read a report that said MRI's are being used instead of mammograms to catch more breast cancers. Why isn't this standard practice? Thanks so much.
After my last path report came, my surgeon scheduled me for what I thought was a surgical biopsy, taking more tissue and trying to get enough for good margins. Yesterday when I had my last appt. prior to my surgery tomorrow, the pre-op form said "lumpectomy." Further, the nurse said not to freak out at the hospital because for coding purposes, the hospital forms would say partial mastectomy. What in the world AM I having??? Are all three the same in the eyes of the insurance world?
Is this just the shell games hospitals play with insurance companies? Is what it is called going to affect my insurance? Since I will be paying for 20% of this, are the costs different depending on what name it is given?
Also, my surgeon said he felt confident that he could tell where the stereotactic procedure was done without having to "use a wire." He mentioned that he could do a floroscope.....and he had been palpating the area to know where the site was. They did insert a metal piece during the first biopsy. Isn't there some better way to know precisely where the site is? Do surgery suites not have the radiology equipment? And without it, how would he place a wire?
Finally, I just read a report that said MRI's are being used instead of mammograms to catch more breast cancers. Why isn't this standard practice? Thanks so much.
Doctor's Answer
by CCF-RN,MSN-JS, Oct 07, 2003 12:00AM
Dear alliecallie, An excisional biopsy, lumpectomy, partial mastectomy, could technically be all the same procedure. I do not know the answers to your questions about the insurance coding, that would be best answered by a financial counselor or billing person at the facility where you are being treated, or by your insurance company.
Placing a wire for localization is done using x-ray guidance, done prior to incision. Every facility has different set-ups for their operating rooms. In our facility the wire is placed in radiology before the patient is transported to surgery - located in a totally different part of the hospital. If the area can be felt the surgeon would know where to make the incision and using fluroscopy in the operating room could locate the metal tag, that has been placed in the area of concern.
Different tests have both pros and cons to there use. MRI is used in conjunction with mammogram, not in place of mammogram. For example, in a person with very dense breasts it may be used to evaluate an area of concern. If additional information was thought to be obtained by using MRI, then it could be used. In terms of using an MRI for general screening purposes, cost, availability, are two reasons that it would not be used to replace mammogram in general screening. There may be circumstances in an individual at high risk where MRI would be used to check for problems.
Placing a wire for localization is done using x-ray guidance, done prior to incision. Every facility has different set-ups for their operating rooms. In our facility the wire is placed in radiology before the patient is transported to surgery - located in a totally different part of the hospital. If the area can be felt the surgeon would know where to make the incision and using fluroscopy in the operating room could locate the metal tag, that has been placed in the area of concern.
Different tests have both pros and cons to there use. MRI is used in conjunction with mammogram, not in place of mammogram. For example, in a person with very dense breasts it may be used to evaluate an area of concern. If additional information was thought to be obtained by using MRI, then it could be used. In terms of using an MRI for general screening purposes, cost, availability, are two reasons that it would not be used to replace mammogram in general screening. There may be circumstances in an individual at high risk where MRI would be used to check for problems.
