19101 , 19125


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Doc office is always booking ultrasound guided needle -localized breast biopsy with CPT code 19101-Biopsy of Breast- open incisional, and cpt codes 19290 and 19291 while I always code them as 19125- Excision of breast lesion idenified by preoperative marker.
Now I bill only 19125 because a radiologist comes to our surgery center and does this, so I assume I cant bill this.So does the doctor bill for this ? Also is cpt code 19125 the correct code ? Secound guessing myself but want to make sure I am coding this correctly. 19101 is an biopsy , just taking a small amount , while 19125 means they are taking out entire lesion , correct ?, If I am correct (hoefully so) how do I approach doctor office on correcting this matter on the booking sheets ?Here is operative report, I appericate any feedback .Thank you , 19125, and 19126 ?

PREOPERATIVE DIAGNOSIS: Nonpalpable right breast mass.

POSTOPERATIVE DIAGNOSIS: Nonpalpable right breast mass.

PROCEDURE PERFORMED: Right ultrasound guided needle-localized breast biopsy.



CLINICAL HISTORY: female with a suspicious area in the lateral aspect of her right breast. Percutaneous biopsy only revealed scar. Note, after the needle was placed, I called and discuss the case with Radiologist. There were actually two areas in question. He came in the operating room and we reviewed the ultrasound. The needle was through a solid mass at 10 o'clock position of the right breast, there was an additional area slightly medial at the 9 o'clock position. I will include both of these in the specimen.

PROCEDURE IN DETAIL: After general anesthesia was initiated, the right breast was prepped and draped in a sterile fashion. A linear incision was made on the lateral aspect of the right breast. Electrocautery was used to dissect through the subcutaneous tissue and dissect down to the area of the mass at the 10 o'clock position, which was marked by the needle. The needle was exteriorized through the skin incision. Dissection was carried down to and around this area. It was then carried medially up to area at the 9 o'clock position. All of the margins were grossly negative. The specimen was marked for orientation and was sent to ultrasound, who confirmed both areas in question within the specimen. The wound was irrigated with normal saline. It was inspected and found to be hemostatic. The subcutaneous tissue was closed with interrupted 3-0 Vicryl suture and interrupted 3-0 nylon was used to close the skin. 10 cc of 0.25% Marcaine with epinephrine were injected for local anesthesia. Sterile dressing was applied. The patient tolerated the procedure well.
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The op report looks like he entirely removed both lesions after a needle localization through a single incision. I would code this as 19125 : excisional breast biopsy not as an incisional (which is only removing a piece of the lesion for pathological examination). I would not however, use 19126 as the lesion was removed with one needle localization, 19126 would mean that two seperate lesions had been needle localized. If he had removed two seperate lesions by two needle localizations than addition of 19126 would be appropriate. I hope this was helpful for you. :) . Also,unless he is the one who actually did the needle localization he cannot charge for that, it would be up to the radiologist to bill for that.
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