Difference Between Breast needle core, Incisional and Excisional Biopsy

Breast Core biopsy is performed by inserting a large gauge needle through the skin of the breast and into the suspected breast tissue.  The needle is removed with the core of the breast tissue. The core of tissue is sent to the laboratory for pathologic evaluation. Pressure is applied to the biopsy site to stop any bleeding. There are different procedure codes for coding breast core biopsy. CPT code 19100 describes a needle core breast biopsy. In addition, we have separate CPT code 19101 for breast core biopsy through an incision. In addition, if any entire lesion is removed we have to use CPT code 19120 instead of CPT code 19101.

Difference Between Breast needle core, Incisional and Excisional Biopsy

                    Coding tips for Screening Colonscopy

CPT codes for Core, incision and Excisional Breast Biopsy


Incisional biopsy can be converted into Excisional breast biopsy sometimes. When an incisional breast biopsy is performed, the sample or specimen is examined immediately by frozen section. If the specimen, mass, or lesion is found to be malignant, extensive procedure may be performed to remove the entire abnormal mass or lesion through excisional biopsy. In such cases, we cannot report incisional we will only report the excisional biopsy CPT code 19120.
19100- Biopsy of breast; needle core not using imaging guidance (separate 
procedure)
 
19101- Biopsy of breast; open incisional
 
19120- Excision of cyst, fibroadenoma, or other benign or malignant tumor aberrant breast tissue, duct lesion or nipple or areolar lesion (except 19300), open,  male or female, one or more lesions
Read also:  Sentinel Lymph node Biopsy coding tips
                     Tips to follow to Clear CPC exam

CPT codes for Placement of Needle localization wire


When a breast abnormality has been detected by mammogram, the abnormal mass or lesion needs to be located for further extensive procedure. Hence, prior to the operation, mammographic techniques are used to place a wire preoperatively to locate the exact site of abnormal mass, lesion or lump in the breast. CPT codes from 
19281-19288 are used to placement of breast localization devices (like wire, clip) which also include the four different imaging guidance.
19281- Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; first lesion, including mammographic guidance
 
+19282- each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure

19283- Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; first lesion, including stereotactic guidance

+19284- each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure

19285- Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; first lesion, including ultrasound guidance

+19286- each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure

19287- Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; first lesion, including magnetic resonance guidance

+19288- each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure


Read also: Coding tips for partial and total Mastectomy

CPT codes for Excision of lesion with Radiologic marker


Once the marker is placed surgeon can easily identify the lesion. Once the lesion is indentified excisional biopsy is carried out in the operating room.CPT code 19125 and 19126 are used for coding excisional biopsy for initial and subsequent lesion of breast.
19125- Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion
+19126- each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure)
Point to remember
Based on the National Correct Coding Initiative (NCCI) edits for hospital reporting, the placement of the localization device(s) is considered inherent with the surgical breast codes that specifically require the use of localization devices (19081–19086) but is not considered inherent to most other surgical breast codes.  It is typically considered inherent only in those breast procedures that require the placement of a marker as an intrinsic part of the service, such as CPT codes 19081–19085.

Use LT or RT modifier with all these procedure codes to specify the laterality of the breast.

Please read the below references for more information:

http://www.radiologytoday.net/archive/rt0814p10.shtml
http://evtoday.com/2013/11/new-cpt-codes-for-2014
https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=13&fromdb=true
http://www.umiultrasound.com/breast-surgery-cpt-codes

Share this

Related Posts

Previous
Next Post »