Coding Challenges in Cpt code for Breast needle core biopsy

Core Breast needle biopsy 2014 challenges.
Breast biopsy (Photo credit: Wikipedia)

 Breast Needle biopsy new updates     

 Breast biopsy procedures are now bundled with the guidance codes in 2014 and now only one CPT code will be enough to code for any breast biopsy procedure with guidance code.
The new bundled breast biopsy codes 19081-19086 and new bundled breast localization codes 19281-19288. Now to code breast biopsy procedure includes six new bundled codes 19081-19086 along with imaging guidance and eight new bundled codes 19281-19288 to report placement for breast localization devices with imaging guidance.
Based on new coding guidelines, for open incisional biopsy of breast after image guided placement of localization device, one has to code CPT 19101 and the appropriate image guided localization device placement CPT code.These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which is surely help in clearing CPC exam.

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NCCI edit of FNA and Breast needle biopsy procedures

Now, since January 2014 NCCI edits shows different story when these services are performed on the same date. Following are some of the NCCI edit combinations effective from January 2014.
Column 1
Column 2
Modifier
10021
19281
1
10021
19283
1
10021
19285
1
10021
19287
1
10022
19281
1
10022
19283
1
10022
19285
1
10022
19287
1
19100
19281
1
19100
19283
1
19100
19285
1
19100
19287
1
19101
19281
1
19101
19283
1
19101
19285
1
19101
19287
1


Whenever one comes across with CPT from column 1 and column 2 on same day, modifier 59 will need to be reported with CPT code noted in column 2. Further NCCI edits exit when reporting placement of needle localization device “first lesion” with CPT code for “each additional lesion” as noted below
Column 1
Column 2
Modifier
19282
19281
1
19284
19283
1
19286
19285
1
19288
19287
1

When to use 52 modifier with breast needle biopsy procedures?

Now, if the physican is performing both surgical and imaging procedure, the physician would get a bundling edit when trying to code both imaging guidance (CPT 76942) and breast biopsy. In 2014 the radiologist would only be reporting CPT 76098. The surgeon would report CPT 19081, breast biopsy with placement of breast localization device (e.g. Clip, metallic pellet), when performed and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance. Since, the surgeon did not perform the entire procedure (excluding imaging of biopsy specimen), CPT 19081 would be reported with modifier 52, reduced services.

Below is one example how to code new breast needle biopsy procedure.

STEREOTACTIC-GUIDED NEEDLE-WIRE LOCALIZATION OF BIOPSY MARKER, RIGHT: 
BREAST
INDICATION: Excision of the area of a biopsied benign phyllodes tumor
right breast 7:00 N4 position in this 24-year-old. 100% of the lesion
was removed at time of vacuum-assisted biopsy on 8/29/2013. A
ribbon-shaped marker was left at the biopsy site.

FINDINGS:
TECHNIQUE:
The risks, benefits and alternatives to the procedure were discussed
with the patient , who understood the above and signed the consent.

Site 1: Right breast 7:00 N4
the technologist and I evaluated the area of previous biopsy with
ultrasound. The marker can no longer be visualized after this many
months and there is no recurrent tumor. Therefore, we proceeded to
stereotactic localization.
Stereotactic localization views were performed. A time out was
conducted to verify that the correct procedure was being performed on
the correct patient. A sterile surgical tray was used.
Following sterile skin prep and administration of local anesthesia, a
Kopans needle-wire localization device was advanced through the area
of concern and hook wire deployed. Stereotactic images were obtained
to document appropriate positioning of the localization wire.
Post-localization digital mammogram demonstrates the wire adjacent to
the marker, but the tip is several centimeters medial to the desired
location. This due to accordion effect when the breast is released
compression.
We returned to ultrasound, and using measurements from the nipple, an
"X" was placed on the skin over the area for the surgeon to target.

IMPRESSION:
Needle-wire localization of breast lesion.
The wire was secured to the patient's skin, and she proceeded to
surgery.
CPT: 19283-RT

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5 comments

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Anonymous
10 June 2014 at 08:10 delete

Reporting open excision of breast lesions (such as lesions of the breast ducts, cysts, benign or malignant tumors), without specific attention to adequate surgical margins,markers using 19125-19126. (Source: CPT instructional notes) is causing editing for NCCI edit when billed the same date/claim with the preoperative placement of radiological clip/device 19283 done by radiologist. Is this accurate? The biopsy 19125 is an open procedure done by surgeon and the clip is placed at a separate encounter preoperatively by radiologist. Please provide guidance on the appropriate way to bill from a CMS or AMA perspective. Thanks.

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16 June 2014 at 23:04 delete

the cpt code 19283 is just a placement for localization device and this device is used as a marker for excision of breast duct or cyt or tumor (19125) . Hence, these two are separate procedure but when done on same day on has to distinct it from one another hence we have to use 59 with 19283 as shown in NCCI edit between them. Also, open procedure of breast does not include placement of radiological marker device, if it include 19125 would be enough to code. But, when they are done together on same encounter we have code both with 59 with 19283 showing it is a distinct procedure compared with 19283. Hope this clarify ur doubt..

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Anonymous
4 January 2016 at 12:39 delete

A lot to learn. Thank you very much for the valuable info

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Anonymous
7 January 2016 at 14:49 delete

What about a percutaneous needle core biopsy using imaging guidance performed at the office by a surgeon? Would 19083 be correct or 19100 and 76942(imaging)?

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4 September 2016 at 06:23 delete

when we have a specific code for biopsy and ultrasound guidance we can code directly 19083 CPT code....cpt code 19100 cannot be used when guidance is used since its description says w/o imaging guidance...we should use 19102 cpt code for with imaging guidance procedure.

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