Health Information Management

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

APCs Insider, March 20, 2015

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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.

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