Health Information Management

Q&A: Can we code marker placement for a breast biopsy?

APCs Insider, March 20, 2015

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Q: An auditor recently told us to code two CPT® codes for a breast biopsy with placement of a marker. We coded 19125 (excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion), but he said we should also code 19281 (placement of breast localization device[s] [e.g., clip, metallic pellet, wire/needle, radioactive seeds], percutaneous; first lesion, including mammographic guidance). This pair triggers a CCI edit so we stopped coding both pieces last year. What should we be doing?
 
A: An edit existed for a short period of time that did indicate CPT code 19281 was a component of 19125. After discussion with the specialty societies, CMS determined this was incorrect and retroactively removed the edit. 
 
Coding Clinic for HCPCS, Second Quarter 2014, addresses this scenario, along with other information about these biopsy procedures. The response stated that placement of localization devices is not considered inherent to most excisions, but is when the use of markers is inherent to the procedure described by the reported CPT code. 
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular