Breast needle localizations

ldolyak

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Cheshire, CT
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Can someone help me when a Breast lumpectomy with needle localization is performed which code is correct the 19125 or 19301. There is no documentation anywhere to support using one or the other. Thanks
 
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hpycoder

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I Would Use 19301 Depending On The Size Of The Lump Removed. The
Payment Would Be Higher From Ins. Company Assuming This Is Not
A Self-pay Patient.
 

AWARDEN

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Lowell, MI
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I have been told that you can use 19301 if a quadrant of the breast was removed or if you are excising to get clear margins for a patient diagnosed with cancer. If you don't meet the above criteria I have been told to use 19125.
 

sundaey

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Las Vegas, NV
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I've used 19125 if the doc uses the clips and doesn't mention clear margins. If he does say that he took care to get margins, then I would use 19301. Hope that this helps.
 

Tvitolo

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19125 and 19301

If a 19125 specimen was sent to pathology and from that result surgeon has to perform a 19301. Can you use a modifier 58 and document both codes?
 

magnolia1

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Albany, New York
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If 19125 is performed initially, and the surgeon subsequently goes back to get "margins", I do not use 19301. (the description of that code in Coders' Desk Reference states the lump/ mass is removed a margin of healthly tissue).

If subsequent surgery is done to remove additional tissue (margin),
I use 19120 (excison of breast tissue).

Karen Maloney, CPC
Data Quality Specialist
 

aguelfi

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The problem I run into is 19125 specifies w/ radiology markers, and 19120 doesn't. My doctor doesn't always include this in his documentation but it's closer to what he actually does. I need to talk to him, but he's not one to listen well. Any suggestions?
 

cmartin

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If, during the initial procedure, seemingly normal tissue is taken in an effort to get clear margins for either invasive cancer or DCIS, I use 19301. If only the abnormal tissue itself is being removed, I use 19125 (or if no localization, 19120). In either case, if a later return is required to get additional tissue for clear margins on CA or DCIS, I use 19301, with the 58 modifier if, as is usually the case, the return is w/in 90 days. I don't understand the point about the desk reference definition - if it's that the "mass" - or most of it - has already been removed, then 19120 seems LESS appropriate to me. Its actual CPT definition states cyst/tumor/lesion/aberrant breast tissue, whereas 19301 just states partial mastectomy, followed by some examples in parentheses. (I always have to put a note in my book: e.g.=for instance; i.e.=that is). So if most or even all of the additiional tissue removed turns out to be "normal", I can't see where 19120 is better than 19301. Just my opinion.
C.Martin CPC-GENSG
 
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