Ob-Gyn Coding Alert

Reader Question:

Breast Biopsy

Question: How should I code for a breast biopsy? Code 19100 refers to 88170 for fine needle aspiration, but that's a lab code. If I use 88170 for the procedure, what should the lab use for its charges?

Alabama Subscriber

Answer: The AMA's CPT Coding Companion, 2001, page 138, provides a thorough answer to this question. In summary, 88170 (fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]) describes the technique for obtaining the cells from a solid tumor or other organ using a fine needle. The lab would report 88172 (cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen[s]) for the path exam of the specimen. 19100 (biopsy of breast; percutaneous, needle core, not using imaging guidance) describes taking a small amount of tissue to be examined by the pathologist histologically, and this is reported by the lab with 88305 or 88307 (level IV or V surgical pathology, gross and microscopic evaluation).

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