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Old 06-09-2009, 09:35 AM
MEZIESKY MEZIESKY is offline
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Default Stereotactic breast question

Not sure what to do with this one. Pt presented for stereotactic breat bx. Pt was placed on the table, breast suspended through the aperture. Multiple attempts were made to localize the abnomality. The pt has very small volume of breast tissue and the localizing coordinates were not suitable for stereotactic bx. The Dr insist there is a code for a aborted procedure. Should I use the modifier 53? If so on which code? 19103? the 19295 is a add on code should i use that also?
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Marie
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Old 06-09-2009, 10:09 AM
mjewett mjewett is offline
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What about billing just for the stereotactic guidance, code 77031 with the appropriate modifier, 26, TC... It sounds like the stereotactic guidance was performed, but the biopsy was not.

Melissa-CPC
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Old 06-09-2009, 10:35 AM
manonb manonb is offline
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Default Cpc

For the billing/reimbursement point of view, I would agree to use modifier 53 on 19103. The procedure was performed but interrupted. if you bill using 26/TC (unbundle the procedure). If you use -53 and provide documentation you should be able to get partial/full reimbursement. Documentation will be the key, (how much time was spent, complexity and reason for interruption)
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Old 06-09-2009, 10:36 AM
manonb manonb is offline
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Default Manon, CPC

For the billing/reimbursement point of view, I would agree to use modifier 53 on 19103. The procedure was performed but interrupted. If you use -53 and provide documentation you should be able to get partial/full reimbursement. Documentation will be the key, (how much time was spent, complexity and reason for interruption)
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Old 06-09-2009, 10:58 AM
magnolia1 magnolia1 is offline
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I am with mjewett on this one.
I see this scenario quite often, and do not code the "biopsy" at all in this case.
The attempt to localize the lesion was done (Radiology code), but the biopsy itself was not started. Only the Radiology service should be billed.
If a modifer could be used, I don't think "53" would be appropriate based on the description of that modifier.
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