Wiki 19103 without image guidance?

[mcarrillo]

I was wondering if it is okay to bill the 19103 without the image guidance, or is it supposed to be included? I have a Dr who stated that she performed a breast biopsy using the SenoRx, which is the vacuum assisted device, for the 19103 code. She doesn't say any imaging guidance was used, and she checks off 'manual' as the assistance being used.

Thank you

 

[donnajrichmond]

If no imaging guidance was used, code 19100 instead of 19103.
(I would clarify first).

Donna J Richmond

 

[mcarrillo]

Donna,
Thank you for the response. The doctor did clarify that she uses the vacuum assisted rotating device, but didn't use imaging. Since the 19100 is a manual needle, is it still appropriate to use? Also, even though the CPT manual says 'using imaging guidance', it does state to report separately (76942, 77012, 77021, 77031, 77032) for the imaging guidance performed in conjunction with the 19103. If the guidance truly is included, wouldn't the manual state not to report it separately?

Thank you

 

[donnajrichmond]

In 2001 the breast biopsy section changed to distinguish between non-imaged guided percutaneous breast biopsy 19100 and imaged guided (19102 and 19103). While 19102 an 19103 require guidance, guidance was not valued into the code because there are different modalities that may be used. So, the notes under 19102 and 19103 give us the code options for the guidance.
If you look at the SenoRX site, all of their breast biopsy products have reimbursement sections giving code recommendations.