Table of Contents

Basics about Breast Biopsy CPT Codes

Breast biopsy are very important to determine the initial stage of breast cancer. Breast biopsy is done in different technique to find the diagnosis related to breast neoplasm. Since, there are some changes in breast biopsy CPT codes , we are here to learn more about them. We already learnt about coding new updated codes for spinal injection . These new CPT codes are similar to breast biopsy procedure, since all the minor procedures, including the guidance (code 77003 for spinal injection) are included from 2017. You may be aware of few basic things but we will try to learn in detail about breast biopsy procedure coding. Let’s check out the description of breast biopsy cpt codes.

19081 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance

+19082 for each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)

19083 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance

+19084 for each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)

19085 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance

+19086 for each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)

19100 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)

19101 open, incisional

19105 Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma

19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions

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)

19081 – 19086 Breast Biopsy with image guided placement of breast localization device(s)

Tips and Tricks for Breast biopsy CPT codes (19081-19086)

Image credit

Definition Breast biopsy CPT codes

We know about the Fine Needle aspiration and Breast Core biopsy CPT codes. For other biopsy procedure like lung biopsy , thyroid biopsy we have direct CPT Code. But, for breast exam we have separate CPT code for breast biopsy with or without guidance. Also, the CPT codes includes the breast localization devices like clip placement, which were coded separately earlier. These procedure are becoming complex than CPT codes for angiogram. These breast biopsy procedure are as interesting as coding Selective and Non-Selective Catheterization Procedure codes.

Percutaneous needle core breast biopsy (CPT code 19100) – The mass is located without the use of imaging guidance and the patient receives local anesthesia. Utilizing a spring-loaded device to insert a 10-14 gauge hollow core needle collect between five and fifteen tissue samples are collected from the mass. Below are few example of Breast biopsy CPT codes.

19100 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)

Percutaneous breast Biopsy with image guided placement of breast localization device(s) (19081-19086) – The mass is located with the use of imaging guidance (stereotactic imaging, ultrasound, or MRI) and a marker is placed; the patient receives general anesthesia or local anesthesia with sedation. A small incision is made with a scalpel. Imaging is used to verify the position of the biopsy device; the needle is fired and the vacuum system is activated. Multiple samples of tissue are removed. Below is the full description of new breast localization device placement codes..

19281 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), 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) (eg, clip, metallic pellet, wire/needle, radioactive seeds), 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) (eg, clip, metallic pellet, wire/needle, radioactive seeds), 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) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance

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

Incisional breast biopsy (19101): The mass is located (often with needle wire localization) and the patient receives general anesthesia or local anesthesia with sedation. A 1 to 4 inch incision is made, a large portion of the mass is removed and the incision is sutured and bandaged. This procedure is highly accurate but can cause scarring and disfigurement which can interfere with future mammograms. If the entire mass is removed, the code for an excision of breast lesion should be assigned (19120- 19126).

Ablation, cryosurgical, of fibroadenoma (19105): Cryosurgical ablation is a minimally invasive procedure which involves freezing of the fibroadenoma by inserting a probe through which a coolant is circulated.

Excision of breast lesions (19120-19126): After the mass has been located, the patient is placed under general anesthesia. The surgeon creates an incision that correlates with the size of the mass and carefully excises the mass or lesion and some of the surrounding tissue. Surgical margins are not specifically considered in the excision of the lesion. The wound is sutured and bandaged.

Also learn about the coding guidelines for CPT codes for Moderate Conscious Sedation used with most of procedure codes. Now, the moderate conscious sedation is coded separately as per the new updates.

Documentation for Breast biopsy CPT codes

History and Physical: A full history and physical should be obtained from the referring physician detailing the signs, symptoms and conditions that deem the breast biopsy or lesion excision necessary. The physician should be aware of all medications the patient is taking as well as pertinent personal and family medical history.

Final Note/Summary: The final note should indicate the procedure(s) performed, and the final pathology findings. Follow up and treatment options should also be documented.

Sign and symptoms associated with breast biopsy cpt codes

Breast Biopsy or Cryosurgical Ablation:

· Questionable finding on mammogram or ultrasound

· Palpable lump or mass

Surgical Breast Excision:

· Questionable results from a biopsy

· Biopsy indicates malignancy

· Lump or mass is large

· Past history of breast malignancies

· Family history of breast malignancies

Do and Don’t

CPT code 19081-19086 are bundled codes with imaging guidance and localization of device placement. Also, when a Mammography (CPT 77065 & 77066) is performed to verify the clip placement, then the mammography is also bundled in the Breast biopsy CPT code 19081-19086.
CPT code 19081-19086 should not be used for Open biopsies.
The “first lesion” should be reported with CPT code 19081, 19083, 19085 and should be reported once per lesion and per session. If lesions are biopsied in both breasts, then code one initial code for first lesion and one for each additional lesion.
Do not add 50 modifier to initial lesion code and additional lesion code.

Points to Remember with Breast biopsy CPT codes

For many of the biopsy procedures, multiple samples may be obtained from the same site or through the same incision to improve the accuracy of the procedure. Do not assign the same procedure code more than once unless samples are taken from the opposite breast or from a distinctly different incision or location of the same breast. Instructions for coding multiple biopsies or excisions are as follows:

· 19100-19101, 19120-19126 – If the same procedure is performed bilaterally, use modifier 50. When samples are taken from different locations using the same method, report the code again and append modifier 59.

· 19081, 19083, and 19085 – Report the code for the first lesion biopsied according to the type of imaging guidance used. Add-on codes 19082, 19084, and 19086 are used to report each additional lesion biopsied with the same imaging modality.

· 19105 – Each fibroadenoma that is ablated is reported separately. There are times when more than one fibroadenoma is ablated with the insertion of only one probe. In these instances 19105 is reported only once. A parenthetical note follows 19105 instructing the coder to follow this convention.

Open breast biopsy and open breast excision are similar in surgical technique. Both procedures utilize an open approach and involve removing tissue for examination. The difference is in the amount of tissue removed. With an open breast biopsy, the physician removes a tissue sample large enough to produce an accurate pathology report. With an open breast excision, the surgeon removes the entire lump or mass and may include a portion of surrounding tissue. If the pathology comes back and the margins are not clear, the surgeon may bring the patient back to the operating room for further lumpectomy or mastectomy.

Note that the breast biopsy CPT codes are not to be used for fine needle aspirations (10021, 10022). Fine needle aspirations differ from biopsies because of the method of collection and involve extracting fluid and/or cells with a long thin needle for cytologic examination. Biopsies involve removing a small piece of tissue for examination, often via a skin excision, for histologic examination. Biopsies can be performed with a needle (e.g., needle core biopsy) but they utilize a large-bore needle.

This short article hopes improves and clear the confusion of coding breast biopsy CPT codes . Share it if you like the article.