Ultrasound-Guided Breast Biopsy:
If Biopsy of the breast is performed using ultrasound guidance,
then we have to assign CPT 19083 (first lesion) and 19084 (additional lesions
biopsied), No need to add ultrasound guidance code as like previously we used
to code, now it is inclusive with the surgery procedures.
- CPT
19083: Biopsy, breast, with the placement of breast localization device(s)
(eg, clip, metallic pellet), when performed, and imaging of the biopsy
specimen, when performed, percutaneous; first lesion, including
ultrasound guidance
- +
CPT 19084: Biopsy, breast, with the placement of breast localization
device(s) (eg, clip, metallic pellet), when performed, and imaging of the
biopsy specimen, when performed, percutaneous; each additional lesion,
including ultrasound guidance (List separately in addition to code for primary
procedure). MUE: 2 Units
· Localization
device placement and specimen imaging are not required for this code, but they
are included if performed.
· These
codes include ultrasound guidance.
How to code Ultrasound-guided breast biopsy: Eg,
1. Single lesion – 19083
2. Two lesions – 19083, 19084
3. Three lesions – 19083, 19084 x 2
Note: No need to add CPT 76942 (US) it’s included with the CPT
19083.
Ultrasound-Guided Breast Cyst Aspiration:
If breast cyst aspiration is performed by using ultrasound
guidance, then we have to assign CPT 19000 (first breast cyst) for additional
cysts use CPT (19001). These codes should be followed by guidance code, for eg,
CPT 76942 (Ultrasound guidance).
- CPT
19000: Puncture aspiration of cyst of the breast, first cyst
- +
CPT 19001: Puncture aspiration of cyst of the breast; each an additional cyst (List separately in addition to code for primary
procedure). MUE: 5 Units
· If the provider performs the procedure under image guidance, then we should use the
appropriate guidance code such as CPT 76942 for ultrasound or CPT 77021 for
magnetic resonance imaging along with CPT 19000.
How to code ultrasound-guided breast cyst aspiration: Eg,
1. Single
cyst – 19000, 76942
2. Two cysts – 19000, 19001, 76942
3. Three cysts - 19000, 19001 x 2, 76942
How to code MRI guided breast cyst aspiration: Eg,
1. Single
cyst – 19000, 77021
2. Two cysts – 19000, 19001, 77021
3. Three cysts - 19000, 19001 x 2, 77021
Note: For
Ultrasound-guided FNA (Fine Needle Aspiration) 10005 & 10006
Ultrasound-Guided Placement of localization device:
- CPT
19285: Placement of breast localization device(s) (eg, clip, metallic
pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including
ultrasound guidance
- +
CPT 19286: Placement of breast localization device(s) (eg, clip,
metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional
lesion, including ultrasound guidance (List separately in addition to code for
primary procedure), MUE: 2 Units
· These codes
include ultrasound guidance.
How to code: Eg,
Single lesion –
19285
Two
lesions – 19285, 19286
Three lesions –
19285, 19286 x 2
Note: No need to add CPT 76942 (US) it’s included with the CPT
19285
Stereotactic Guided Breast Biopsy:
- CPT
19081: Biopsy, breast, with the placement of breast localization device(s)
(eg, clip, metallic pellet), when performed, and imaging of the biopsy
specimen, when performed, percutaneous; first lesion, including stereotactic
guidance.
Note: When a provider performs more than one breast biopsy using
the same imaging modality, use add on code whether the additional service is on
the same or contralateral breast.
For example, for each additional lesion biopsied under stereotactic guidance
whether the additional lesion is on the same or contralateral breast, Use
+19082.
If the physician performs the additional biopsies using different
imaging modalities, report another primary code for each additional modality.
- +
CPT 19082: Biopsy, breast, with the placement of breast localization
device(s) (eg, clip, metallic pellet), when performed, and imaging of the
biopsy specimen, when performed, percutaneous; each additional lesion,
including stereotactic guidance (List separately in addition to code for
primary procedure). MUE: 2 units
· These codes
include stereotactic guidance.
How to code: Eg,
Single lesion –
19081
Two
lesions – 19081, 19082
Three lesions –
19081, 19082 x 2
Stereotactic Guided Placement of Localization device in Breast:
- CPT
19283: Placement of breast localization device(s) (eg, clip, metallic
pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including
stereotactic guidance.
- +
CPT 19284: Placement of breast localization device(s) (eg, clip,
metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional
lesion, including stereotactic guidance (List separately in addition to code
for primary procedure). MUE : 2 Units
· These codes
include stereotactic guidance.
How to code: Eg,
Single lesion – 19283
Two
lesions – 19283, 19284
Three lesions –
19283, 19284 x 2
MRI Guided Breast Biopsy:
- CPT
19085: Biopsy, breast, with the placement of breast localization device(s)
(eg, clip, metallic pellet), when performed, and imaging of the biopsy
specimen, when performed, percutaneous; first lesion, including magnetic
resonance guidance
- CPT
19086: Biopsy, breast, with the placement of breast localization device(s)
(eg, clip, metallic pellet), when performed, and imaging of the biopsy
specimen, when performed, percutaneous; each additional lesion, including
magnetic resonance guidance (List separately in addition to code for primary
procedure), MUE : 2 Units
· These codes
include MRI guidance.
How to code: Eg,
Single
lesion – 19085
Two
lesions – 19085, 19086
Three lesions –
19085, 19086 x 2
MRI Guided Placement of Localization device:
- CPT
19287: Placement of breast localization device(s) (eg clip, metallic
pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including
magnetic resonance guidance
- CPT
19288: Placement of breast localization device(s) (eg clip, metallic
pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion,
including magnetic resonance guidance (List separately in addition to code for
primary procedure), MUE : 2
Units
· These codes
include MRI guidance.
How to code: Eg,
Single lesion –
19287
Two lesions
– 19287, 19288
Three lesions – 19287,
19288 x 2
Note: To report bilateral image-guided breast biopsies, report 19081,
19083, or 19085 for the initial biopsy. The contra-lateral and each additional
breast image guided biopsy are then reported with code 19082, 19084 or 19086.
Breast biopsies, without image guidance, are reported with CPT
19100 and 19101.
- CPT
19100: Biopsy of the breast; percutaneous, needle core, not using imaging
guidance (separate procedure), MUE: 4 Units
· When the provider performs a biopsy on more than one site on the same side, report the
subsequent biopsies with modifier 59.
· - CPT 19101: Biopsy of the breast; open, incisional, MUE: 3 Units
Incisional
biopsy is different from an excisional biopsy. An incisional biopsy, the provider
removes only a small lump that she sends to pathology for further analysis; an excisional biopsy involves removal of the entire lump.
Points to be remembered:
- When more than
one biopsy or localization device
placement is performed using the same imaging modality,
use an add-on code whether the additional service(s) is
on the same or contralateral breast.
- If additional biopsies or localization device placements are performed using different imaging modalities, report another primary code for each additional biopsy or localization device placement performed using a different image guidance modality.
- Do not report 19281-19288 in conjunction with 19081-19086, 76942, 77002, and 77021 for same lesion.