Ob-Gyn Coding Alert

Find out which modifier to use when your ob-gyn removes lesions from both breasts

When your ob-gyn excises a breast cyst or lesion, you need to know two important pieces of information before you even think about choosing a code: whether or not the ob-gyn preoperatively placed a radiologic marker, and whether or not the ob-gyn removed adequate surgical margins in addition to the lesion. Markers May Mean Reporting Radiological S&I On the off chance your ob-gyn - instead of a radiologist - documents placing the marker during a lesion excision, you should code for that placement using 19290 (Preoperative placement of needle localization wire, breast) and +19291 (... each additional lesion [list separately in addition to code for primary procedure]) as well as the radiology code that represents the guidance used to place the marker.

Among your options of codes to report with the marker placement are stereotactic localization (76095, Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation), mammographic guidance (76096, Mammographic guidance for needle placement, breast [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) and ultrasound guidance (76942, Ultrasound guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). This means if the ob-gyn placed the marker and did the guidance, you would use one of these codes for the guidance portion of the service, depending on what your ob-gyn documented.
 
If the ob-gyn placed the marker and removed the lesion, you would code and bill for both procedures and the guidance used for the marker placement (a total of three codes), says Sangeeta Parekh, CPC, practice plan administrator for the USC Department of Surgery, Division of Tumor and Endocrine Surgery, in Los Angeles. Learn 3 Lesion Codes You've got three coding options when reporting excision of a breast lesion while leaving the surrounding tissue intact:
  19120 - Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (expect 19140), open, male or female, one or more lesions

19125 - Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion
  +19126 - ... each additional lesion separately identified by a preoperative radiological marker (list separately in addition to code for primary procedure). If the ob-gyn performs an excision of adequate surgical margins, however, you should bump up your code to the level of a partial mastectomy, according to the CPT guidelines.

Keep in mind: When the ob-gyn identifies the breast lesion preoperatively by the placement of a radiological marker, you should report 19125 instead, Parekh says. You'll use this code for the first lesion. For any additional lesion, you [...]