General Surgery Coding Alert

Question: Our surgeon placed localization devices for two lesions in the patient’s left breast using ultrasound guidance. How should we code the procedure?

Tennessee Subscriber

Answer: Report 19285 (Placement of breast localization device[s] [e.g., clip, metallic pellet, wire/needle, radioactive seeds], percutaneous; first lesion, including ultrasound guidance) and +19286 (…each additional lesion, including ultrasound guidance [List separately in addition to code for primary procedure]).

CPT^® provides eight codes in the range 19281-19288 for breast localization device placement. With multiple choices, you need to consider factors such as the imaging method and number of lesions to code these cases correctly. Notice that each imaging method has two codes — one for the initial lesion and an add-on code for each additional lesion marked with that method.

Caution: Use 19281-19288 only for placement of localization devices, such as a clip, metallic pellet, wire, or radioactive seeds without a biopsy. For localization device placement with a biopsy, turn to other codes such as 19081-19086 (Biopsy, breast, with placement of breast localization device[s] [e.g., clip, metallic pellet], when performed, …). Don’t report codes from the two families together for the same lesion, because codes 19081-19086 include placing the localization device.