Summary & Overview
CPT 19112: Excision of Lactiferous Duct–Skin Fistula
CPT code 19112 denotes surgical excision of a fistula connecting a lactiferous (milk) duct to the skin. This targeted breast surgical procedure is clinically relevant for patients with persistent duct-skin fistulas that can cause drainage, recurrent infection, or pain. Nationally, accurate coding of 19112 supports appropriate clinical documentation and claims processing for breast-conserving surgical management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical scope, typical sites of service, and where 19112 fits within breast surgical care. The discussion highlights typical billing considerations, common modifiers used with surgical codes, and areas where documentation affects coverage and payment decisions.
This publication provides benchmarks and policy context relevant to hospitals and ambulatory surgery centers, along with clinical context for surgeons and coding teams. It outlines what counts as the service described by 19112 and what information payers commonly require for adjudication. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 19112 describes the excision of a fistula between a lactiferous duct and the skin. The procedure involves surgical removal of a tubular connection that communicates from a milk (lactiferous) duct to the skin surface.
Service Type: Surgical excision of breast duct fistula
Typical Site of Service: Outpatient surgical suite or ambulatory surgery center, and may also be performed in an inpatient operating room depending on clinical context and patient factors.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with recurrent nipple drainage, localized periareolar skin irritation, or a palpable tract consistent with a lactiferous duct-skin fistula. Evaluation includes history (prior trauma, prior duct procedure, lactation history, signs of infection), focused breast exam, and targeted imaging such as diagnostic mammography and ultrasound to localize the ductal tract. If infectious signs are present, culture and short course antibiotics may be given before definitive excision. The procedure 19112 is performed in an ambulatory surgical center or hospital outpatient setting under local anesthesia with sedation or general anesthesia depending on extent and patient factors. The surgeon identifies and excises the entire fistulous tract from the skin to the involved lactiferous duct, achieves hemostasis, and closes the wound primarily; specimens may be sent to pathology if indicated. Postoperative care includes wound care instructions, pain control, and follow-up for wound check and pathology review. Common payors for authorization and claim submission include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for excision of duct-skin fistula due to extensive dissection or infected/complex tract requiring additional time and effort. |
23 | Unusual anesthesia | Use when general anesthesia is required for medical reasons rather than the typical local/regional anesthesia. |
26 | Professional component | Use when splitting technical and professional components for services (rare for this procedure) — e.g., if professional only billing is submitted separate from facility technical services. |
50 | Bilateral procedure | Use when bilateral lactiferous duct fistulae are excised and payer requires bilateral modifier reporting. |
51 | Multiple procedures | Use when 19112 is performed in the same operative session with other distinct procedures and payer requires reporting of multiple procedures. |
52 | Reduced services | Use when the procedure is intentionally partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use if the procedure is started but terminated due to patient condition or other unforeseen intraoperative complication. |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure when 19112 is performed in addition to another procedure in the same anatomical region and documentation supports distinctness. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct parts of the excision requiring equal skill. |
76 | Repeat procedure by same provider | Use when the same surgeon repeats the procedure during the global period for reasons documented (not in provided modifier list but commonly used); Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207P00000X | General Surgery | Most commonly performs excision of ductal-skin fistulae in adult patients. |
| 207L00000X | Breast Surgery (Surgery of the breast) | Specialists in breast-conserving procedures and complex ductal repairs. |
| 208000000X | Obstetrics & Gynecology | May manage lactation-related duct issues and perform minor breast procedures in select settings. |
| 2086S0123X | Family Medicine | May perform minor procedures or refer; includes clinicians who manage initial presentation and follow-up. |
| 363LP0800X | Plastic Surgery | Involved when complex reconstruction or secondary closure techniques are required. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N64.89 | Other specified disorders of breast | Covers localized nipple/areolar disorders including fistulae when a more specific code is not applicable. |
N64.4 | Mastitis, unspecified | Infection of breast tissue that can lead to abscess formation and subsequent duct-skin fistula requiring excision. |
N61 | Inflammatory disorders of breast | Includes periductal inflammation that may form chronic draining tracts. |
N63 | Unspecified lump in breast | Palpable lesion adjacent to a fistulous tract that may require evaluation or concurrent excision. |
R59.0 | Enlargement of lymph nodes, axillary | Regional lymphadenopathy that may be present with chronic infection or inflammation related to a fistula. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19000 | Aspiration of cyst of breast | Performed preoperatively for diagnostic relief if a cyst is suspected or to evaluate recurrent nipple discharge before definitive excision. |
19001 | Biopsy of cystic lesion | Used when a targeted cystic lesion requires biopsy rather than full fistula excision. |
19120 | Excision of lesion of breast; open, duct excision (e.g., for ductal papilloma) | Performed when more extensive ductal excision is required beyond a single fistulous tract; may be performed concurrently or as alternative. |
19301 | Partial mastectomy, focal lumpectomy | Performed when a larger breast lesion is identified requiring wider excision in addition to fistula management. |
48800 | (Data not standard for breast; unrelated) | Data not available in the input. |