Breast needle localizations


Cheshire, CT
Best answers
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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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.
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.
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.
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?
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
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?
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.