General Surgery Coding Alert

Question: I have a general surgery coding companion book which says that we can bill +19295 for the placement of the clip when our surgeon places a clip for a patient who has a breast mass. However, we're not getting paid. Should we still be reporting the code?

Maryland Subscriber

Answer: Code +19295 (Image guided placement, metallic localization clip, percutaneous, during breast biopsy ...) is for placing a clip. However, there is no reimbursement for this code.

How it works: If you look at the relative value unit (RVU) structure for +19295 you will see that there is no monetary value assigned for work (that's the work of placing the clip), a small amount assigned for practice (that's the actual cost of the clip), and a tiny amount assigned for malpractice.

When CPT created +19295 it decided that the physician work was so minimal with the clip placement that there should be no separate reimbursement for that part of a procedure. Since there is no work reimbursement it doesn't matter if you report +19295. You will not be paid for your surgeon placing the clip.

Why? When the place of service is 21 (Inpatient hospital) or 22 (Outpatient hospital) or another facilitybased location, the physician only receives the work portion of the code. Payers reimburse the facility for the supply.