Devices and Method of Guidance Clarify Breast Biopsy Codes
Published on Tue May 01, 2001
For years, breast biopsies coding has been confusing because new procedures and equipment were implemented faster than applicable codes were added. Coders were forced to weigh multiple clinical factors and coding options to determine which mix of codes best described the services provided. This situation was clarified in 2001 when CPT Codes added and revised codes to better reflect current procedures and equipment.
Biopsies are performed using one of several techniques after an abnormality has been identified during a physical breast examination or by radiologist-performed mammography, which in some cases is followed by breast ultrasound. Areas with suspicious radiographic findings (e.g., lumps, masses, clusters of microcalcifications) are among the irregularities that are biopsied to determine malignancy.
Coding Breast Cyst Aspirations
If the ultrasound indicates that the abnormality is a cyst (i.e., fluid-filled), an aspiration may be performed. Aspiration is both a therapeutic and diagnostic procedure because fluid and cells are drained from the cyst (therapeutic) and sent to pathology for evaluation (diagnostic).
Although the procedures are virtually identical, two codes describe an aspiration. Typically, when the ordering physicians intent is for an aspiration only, a fine needle aspiration (88170, fine needle aspiration; superficial tissue [e.g. thyroid, breast, prostate]) would be used to report the procedure.
When the primary intent is for the radiologist to decompress a cyst with pathological analysis, coders may instead assign 19000 (puncture aspiration of cyst of breast) to the surgical component of the cyst aspiration. If more than one cyst is treated during the session, add-on code 19001 (... each additional cyst [list separately in addition to code for primary procedure]) would also be reported, according to Jacqui Szymanski, RT (R), M, practice administrator for Associated Imaging Specialists, a practice of six radiologists in Elgin, Ill.
The radiologist would be performing aspirations under ultrasound guidance, Szymanski notes, since ultrasound is the only modality that can differentiate between air and fluid, or a solid mass. This makes it ideal for locating a cyst. According to CPT 2001, coders would use 76942 (ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). In the past, she says, coders would have assigned 76938, but that code has been deleted.
Percutaneous, Needle Core Breast Biopsies
When the mass is solid, the radiologist may perform a breast biopsy. Whether or not imaging is required, as well as what type of device is used, determines which of the biopsy codes will be assigned. CPT made modifications and additions to the codes in 2001, which made choosing a code much easier, says Edward Spiers, [...]
