Focus on Total Lesions Rather Than Laterality for Breast Biopsy Reporting
Question: I have a report that lists the procedure as percutaneous biopsies of lesions of the right and left breasts. The report indicates that the physician collected samples from one lesion in each breast. The provider used ultrasound (US) guidance for needle placement. How do I report bilateral breast biopsies? California Subscriber Answer: Use 19083 (Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance) to report the first breast lesion biopsy performed with US guidance. You’ll also assign +19084 (… each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)) to report the additional breast lesion biopsy performed with US guidance. According to the CPT® guidelines, “report … 19083 … for the initial biopsy. The contralateral and each additional breast image-guided biopsy are then reported with … +19084 ….” For example, if the surgeon biopsies four lesions on the right breast and two lesions on the left breast, you’d report 19083 and 5 units of +19084 to total six lesions biopsied. The CPT® guidelines don’t instruct you to specify laterality when reporting the biopsies; just include the correct number of codes to match the total number of lesions biopsied. However, each payer has different preferences regarding reporting rules. Payer preferences: Check with your individual payer to learn if it needs modifiers, such as RT (Right side) and LT (Left side), to indicate which side of the body the provider performed each biopsy. For example, 19083-RT and +19084-LT show the payer that the physician captured a biopsy of the first lesion on the right breast and collected a sample from a second lesion on the left breast. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
