General Surgery Coding Alert

Focus on guidance to select proper code.

Five codes for percutaneous breast biopsy and placement of localization devices won’t cut the mustard next year. Instead, CPT^® 2014 deletes the existing five codes and replaces them with 14 new, more specific codes that you need to know.

Drop Deleted Codes

CPT^® 2014 removes the following codes, effective Jan. 1, 2014:

• 19102 — Biopsy of breast; percutaneous, needle core, using imaging guidance
• 19103 — Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance
• 19290 — Preoperative placement of needle localization wire, breast
• +19291 — Preoperative placement of needle localization wire, breast; each additional lesion (List separately in addition to code for primary procedure)
• +19295 — Image guided placement, metallic localization clip, percutaneous, during breast biopsy/aspiration (List separately in addition to code for primary procedure).

Read on for expert guidance on how to report these services in 2014, once the preceding codes are no longer valid.

Confirm Image Guidance for Localization Devices

You surgeon may use one of several types of imaging guidance when placing a localization device. Your first step for choosing the right code is to confirm the type of guidance used. Then you should look at the new 2014 CPT^® code set to assign a code for the first and each additional lesion.

You’ll select from the following localization techniques, according to Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, director of reimbursement and advisory services, Altegra Health, Inc. in Los Angeles:

• Mammographic guidance: using radiation/X-ray image of breast tissue to verify the placement of the localization device near the targeted tissue
• Stereotactic guidance: a special mammography machine using x-rays to help guide the provider’s instruments to the site of the abnormal growth
• Ultrasound guidance: high frequency sound waves (ultrasound) are sent and received by a machine, creating image used to guide needle placement
• Magnetic resonance guidance: use of powerful magnetic fields and radiofrequency pulses to create detailed images.

The following table shows how the new CPT^® 2014 codes capture the guidance type and number of lesions for breast localization procedures, according to Loya.

Keep in mind: CPT^® codes +19282, +19284, +19286 and +19288 are add-on codes, so you should report them only in addition to the primary procedure code.

Check to Ensure Documentation Supports Breast Biopsy

“2014 will offer you three new codes for breast biopsy using localization devices,” says Loya. These codes are structured much like the placement of the localization device codes in the chart. They too require the use of a primary CPT^® and add-on code for each additional lesion. The new codes are as follows:

Important: Codes 19081, 19083, and 19085 are for percutaneous biopsy of the first lesion in the breast. For each additional lesion biopsied, you report codes +19082 (……..each additional lesion, including stereotactic guidance [List separately in addition to code for primary procedure]), +19084 (……each additional lesion, including ultrasound guidance [List separately in addition to code for primary procedure]), +19086 (…………each additional lesion, including magnetic resonance guidance [List separately in addition to code for primary procedure]) for stereotactic, ultrasound, or MRI guidance, respectively.

Remember: CPT^® codes +19082, +19084 and +19086 are add-on codes, so you should report them only in addition to the primary procedure code.