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Coding tip: Understand breast biopsy types

Ambulatory Surgery Reimbursement Update, November 6, 2007

Breast excision codes are unilateral codes that require bilateral modifiers (modifier -50, modifier -RT, or modifier -LT, as appropriate) if the physician performs a breast excision on both breasts. If the physician performs a breast excision only on one side, append the correct modifier -RT or modifier -LT.

There are two types of breast biopsy codes in the breast section of the CPT Manual. A physician can perform a biopsy either percutaneously or as an open procedure. Biopsies involve the removal of differing amounts of tissue for diagnosis and different methods.

Report breast biopsies using CPT codes 19100-19103. Report open excisions of breast lesions using CPT codes 19110-19126. You would not specifically consider the qualifications of surgical margins and you may include preoperative placement of radiological markers. If the physician uses ultrasound guidance for needle placement (procedure codes 19102 and 19103), you would code the ultrasound guidance using code 76942-TC, which some payers may not reimburse. For the open excision of breast lesions using preoperative placement of a radiological marker, use code 19125 for an open procedure for a single lesion, and use add-on code 19126 for each additional lesion separately identified.

This tip is brought to you by Ellis Medical Consulting, Inc.

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