Breast biopsies are very common procedure in interventional radiology coding. When I started coding breast biopsy, I used to code the biopsy and imaging guidance separately. But, later with new updates, CPT codes for breast biopsy and imaging guidance were bundled. This has made the job of a coder lot easier. Also, now we have separate CPT code for breast biopsy without guidance and breast biopsy with guidance. The CPT code 19100 and 19101 are used for breast biopsies without imaging guidance. Also to report image guided breast biopsy with placement of localization devices, we have use CPT code from 19081-19086. For coding imaged guided placement of localization devices without image guided biopsy, we have separate CPT codes 19281-19288. Let use check these CPT codes in details.

Read also: Best coding tips for Abscess Drainage Procedure codes

CPT code description for 19281-19288

First we will check for the code description of breast biopsy without imaging guidance. CPT code 19100 and 19101 is used for reporting these procedures. Below is the detail code description for these CPT codes.

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

19101– open, incisional

Their are other other diagnostic exam are also done in radiology for breast. For diagnostic & Screening exam of breast/mammogram we have separate CPT codes. Also for Ultrasound exam of breast we have different procedure codes.

Now for coding breast biopsies 19081-19086, you can get detail code description of these codes in my old post. Now, coming to the CPT codes for image guided placement of localization devices without biopsy, the detail code description is as below.

19281         Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; first lesion, including mammographic guidance

+19282      Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure.)

19283         Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; first lesion, including stereotactic guidance

+19284      Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure.)

19285         Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; first lesion, including ultrasound guidance

+19286      Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure.)

19287         Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; first lesion, including magnetic resonance guidance

+19288      Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seed(s), percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure.)

From 2020, CPT code set revise guidelines were added in the introduction of the Breast subsection to instruct reporting the appropriate percutaneous image-guided localization device placement code(s) (19281-19288) when performed prior to an open breast biopsy or open excision of a breast lesion. This includes percutaneous placement of a breast localization device prior to the intraoperative (ie, skin-to-skin) component of an open mastectomy procedure.

During image-guided percutaneous clip placement, typically performed by a radiologist or surgeon, views are obtained which will be used for pre-surgical planning. For example, part of the preservice work for a partial mastectomy (19302) is to review the localization mammogram with the radiologist, who performed the needle-localization procedure, so that the surgeon can plan the optimal location of the skin incisions and operative approach to the area of concern.

A typical scenario is one that would involve a patient who undergoes image-guided percutaneous placement of a localization device (eg, clip or wire) in the radiology department, and later undergoes an open partial mastectomy in the operating room. If, for example, mammographic imaging were used to percutaneously place the device, the radiologist would report code 19281, Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance. The radiologist does not append a modifier to code 19281 if no other services were performed.

Read also: Best coding tips for Endometrial Biopsy for surgery coders

Use of CPT code 19281, 19283, 19285 and 19287 with add-on codes

When more than one biopsy or localization device placement is performed using same imaging guidance, we have to use and add-on code irrespective of same or contralateral breast. But, when additional or another biopsy is performed using different guidance use a different primary CPT code for each additional biopsy or localization device performed with different guidance. For open incisional biopsy with image guided placement of localization device is reported with CPT code 19101. For coding bilateral image-guided placement of localization devices, use CPT code 19281, 19283, 19285, or 19287 for the initial lesion. The contra-lateral and each additional breast image-guided localization device placement should be reported with CPT code 19282, 19284, 19286 or 19288.