General Surgery Coding Alert
Number of Incisions Determines Biopsy Billing
Question: The surgeon performed three ultrasonic-guided incisional breast biopsies on the right breast of a 40-year-old female. Two ultrasonic breast biopsies on the left were also obtained. Only one incision was performed on each breast. How should this session be coded?
Arizona Subscriber
Note: Some carriers may prefer that modifier -50 (bilateral procedure) be appended to 19101 instead of modifiers -LT and -RT.
The number of incisions, not the number of biopsies, determines the number of biopsy codes. In this case, one biopsy per breast was performed, so 19101 should be billed with modifiers indicating that the procedure was bilateral.
If the surgeon or the practice does not own the equipment used for the ultrasonic needle placement guidance, modifier -26 (professional component) should be appended to 76942.
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