There were separate codes for breast biopsy procedures along with guidance. We have to assign multiple codes for breast procedures earlier. However, from 2014 we have bundled CPT codes of breast biopsy with guidance. Breast biopsy CPT codes helps in coding the Interventional radiology procedures easily. We have individual code for breast biopsy with guidance. Lets checkout the new breast biopsy cpt codes.

These new codes include the use of imaging guidance; placement of a localization device such as a metallic clip, pellet, etc (if performed); and specimen imaging (if performed). Biopsy codes may be assigned only once per lesion, so the codes include multiple samples from a single lesion. Biopsies from a separate lesion can be coded separately, so it’s important that the physician documentation clearly defines each separate lesion. The National Correct Coding Initiative (NCCI) edits bundle the following procedures and codes into 19081 to 19086:

• localization device placement (19281, 19283, 19285, and 19287);

• specimen X-ray (76098); and

• image guidance (eg, 76942, 77002, 77012).

Table of Contents

Breast Biopsy CPT Code CPT code 10981 & 19082

Before, we used to code Breast biopsy code separately with stereotactic guidance CPT Code. However, from 2014 we have been provided with bundled CPT code including stereotactic guidance. We have two codes for breast biopsy with stereotactic guidance, 19081 and 19082. Now, when the breast biopsy is done on the first lesion with the help of stereotactic guidance we use 19081. Cpt Code 19082 is an add-on code. It should be always used with 19081. Breast biopsy done for each additional lesion, CPT code 19082 is used.

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

Breast biopsy CPT Code 19083 & 19084

Here we have the same thing to follow, the only difference is about the ultrasound guidance. Here also we have two CPT codes for first lesion and for each additional lesion. The cpt codes used for the ultrasound guided breast biopsy are 19083 and 19084. The breast biopsy performed with ultrasound guidance for first lesion is coded with 19083. For each additional lesion add-on code is used 19084. 19084 is never used primary and should be always used with 19083.

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

Breast biopsy CPT Code 19085 & 19086

MR guided breast biopsy procedure also have two CPT codes. Here, also we will have a primary CPT code for first lesion and an add-on code for each secondary lesion. The cpt code used for MR guided breast biopsy procedures are 19085 and 19086. 19085 is used as primary code for first lesion with 19086 for each addition lesion.

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

CPT Codes for Localization Device Placement in Breast

Bbreast biopsy CPT Codes added from 2014 with CT guidance

CT guided breast biopsy have separate codes earlier for breast biopsy and CT guidance. However, from 2014 they have deleted only the main breast biopsy procedure. Here, we have slight difference in primary CPT code. We will have two codes here because we do not have any bundled CPT code for CT guided breast biopsy like others. In 2014, we are using an unlisted CPT code for breast procedure 19499 as primary code for CT guided breast biopsy. We will also code the CT guidance code 77012 along with 19499. Hence, we will code an unlisted CPT code for CT guided breast biopsy for first lesion.

19499 Unlisted breast procedure
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation

For each addition lesion studied, we can code again the unlisted 19499 CPT code with 59 modifier.

Read also: Coding tips for Breast Reconstruction CPT codes

Coding for Post biopsy Mammogram

Postbiopsy mammograms are performed to verify the clip deployment. Clip is placed into the breast to mark the site of biopsy in case the tissue proves to be cancerous and additional surgery is required. This clip is left inside the breast and is not harmful to the body. Postbiopsy mammogram are included in breast biopsy and metallic localization clip placement procedures.

If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance, then the physician should not separately report a post procedure mammography code (eg, 77065-77067) for the same patient encounter. The radiologic guidance codes include all imaging by the defined modality required to perform the procedure.

For stereotactic procedures, the postprocedure mammogram should only be reported only if the patient is moved to a dedicated mammography unit. If the postprocedure exam is performed on the stereotactic table, it is not separately reportable. When a mammograms is performed following a mammographically guided procedure, the mammogram is always considered to be included in the mammographic guidance and should not be coded separately.

CPT codes for breast localization device placement

Their is separate list of Beast localization device like metallic pellet or clip placement. These procedures codes are also bundled and include the guidance codes and post mammogram procedures. Below is a detail code description of these CPT codes.

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)

The scenarios below demonstrate appropriate coding for percutaneous breast biopsies using image guidance.

Scenario #1

A percutaneous biopsy is performed on a single breast mass with placement of a clip using ultrasound guidance.

Code(s) 19083

Scenario #2

A percutaneous breast biopsy is performed of a right outer quadrant mass in the left breast with stereotactic guidance and of a second lesion in the left lower quadrant of the left breast with ultrasound guidance.

Scenario #3

A localization device is placed under ultrasound guidance in a single breast mass.

Code(s) 19825

Scenario #4

Localization devices are placed percutaneously in two breast lesions both under stereotactic guidance.

Code(s) 19283 and +19284

Code(s) 19081 and 19083

Coding Ultra sound guided breast biopsy

Single lesion – 19083
Two lesions – 19083, 19084
Three lesions – 19083, 19084 x 2

Coding ultrasound guided breast cyst aspiration:

Single cyst – 19000, 76942
Two cysts – 19000, +19001, 76942
Three cysts – 19000, +19001 x 2, 76942

Coding Stereotactic Guided Breast Biopsy

Single lesion – 19081 Two lesions – 19081, 19082 Three lesions – 19081, 19082 x 2

Hope you can get more information about new breast biopsy CPT Codes through this article. If you like the article do share it.

References:

https://www.facos.org/OS/Navigation/News___Publications/Practice_Management/Practice_Management_2015/Coding_Percutaneous_Breast_Biopsies.aspx

https://www.radiologytoday.net/archive/rt0814p10.shtml

Tips for Breast biopsy CPT Codes with Stereotactic imaging guidance