Surgical and radiological oncology coders, you can increase the size of your breast biopsy payments. New Medicare coverage for radiologic services and expert advice on navigating through pathology reports will get you the ethical reimbursement you deserve. Radiologists: Look at BIRADS Level Medicare has loosened the straps on breast biopsy imaging coverage. On Jan. 1, 2003, Medicare started covering percutaneous image-guided breast biopsies, says Jan Rasmussen, CPC, president of the Eau Claire, Wis.-based Professional Coding Solutions and a former member of the AAPC advisory board. To read the program memo, refer to CMS policy AB-02-128. Go to
http://cms.hhs.gov/manuals/pm_trans/ab02128.pdf. You should expect Medicare coverage for radiographic nonpalpable lesions graded via the breast imaging reporting and data system (BIRADS) as probably benign (III), suspicious abnormality (IV), or abnormality (V). Medicare also covers breast biopsy imaging for palpable lesions "that are difficult to biopsy using palpation alone." If you look on your mammograms, you will find that most radiography reports now list the BIRADS level, Rasmussen says.
The applicable CPTcodes that apply to the breast biopsy imaging coverage include:
10022 Fine needle aspiration; with imaging guidance
19102 Biopsy of breast; percutaneous, needle core, using imaging guidance
19103 percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance. Separately report appropriate imaging codes, such as 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]), Rasmussen says. Also note that you don't yet have ICD-9 codes to identify BIRADS III, IV and V that would make supporting the imaging easier, she adds. So expect some trouble with uninformed payers.
You should warn your physicians that carriers may start requiring that the operative notes document the BIRADS level and encourage them to start making that notation now, Rasmussen says. "Better to be forearmed and forewarned."
If the palpable lesion is difficult to biopsy using palpation and therefore covered by Medicare you must submit documentation in the note that shows that difficulty, Rasmussen says. Contractors will then use their discretion to decide whether the palpable lesions were, in fact, difficult to biopsy. Oncologists: Know How to Pick Them To get breast biopsy codes paid, you need to select the correct diagnosis from the pathology report. And you can't go into that half-heartedly.
"It's your responsibility as coders to pull the correct code from this information" in the pathology report, says Marcella Bucknam, CPC, CCS-P, CPC-H, HIM program coordinator at Clarkson College in Omaha, Neb. There are many types of benign and malignant neoplasms, and the pathology report will reflect that range. The report could say squamous cell carcinoma, breast tissue with fibrocystic changes, normal breast tissues with hyperplastic changes, or simple cyst. And it may describe that the cells have their origin [...]
