Wiki CPT Code for Placement of Mammosite Cavity Evaluation Device

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lbancroft

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HELP! Does anyone know the CPT for placement of Mammosite Cavity Evaluation Device? I am coding for the surgeon in an out-patient facility.

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Ced

According to the CPT assistant if placing an expandable catheter device at the time of a partial mastectomy, code 19499, Unlisted procedure, breast, should be reported in addition to the appropriate mastectomy procedure code.

Code 19296, Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelemnt application following a partial mastectomy, includes imaging guidance, on date seprate from partial mastectomy, should be reported for the exchange of the cavity evaluation device with the insertion of a radiotherapy afterloading balloon catheter that is performed on a separate date from that of the breast excision. I hope this helps.
 
Ced

rlacasse said:
According to the CPT assistant if placing an expandable catheter device at the time of a partial mastectomy, code 19499, Unlisted procedure, breast, should be reported in addition to the appropriate mastectomy procedure code.

Code 19296, Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelemnt application following a partial mastectomy, includes imaging guidance, on date seprate from partial mastectomy, should be reported for the exchange of the cavity evaluation device with the insertion of a radiotherapy afterloading balloon catheter that is performed on a separate date from that of the breast excision. I hope this helps.
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I am wondering if we actually can bill the placement of the Cavity Evaluation Device (CED) separately. We have many payers that deny this code as included, not separately payable. It is in the same incision site as the partial mastectomy. It is a place holder until it is exchanged for the MammoSite RTS applicator. I know the MammoSite representatives have a coding and reimbursement guide that indicates to use the 19499 for the placement of the CED; however, with this being unlisted, many payers require prior authorization for this and I wonder if it really is separately billable. Could someone share with me coding logic i.e. NCCI manual info that allows this to be separately billed? I am wondering if this is a part of the medical / surgical standard of care and is included in the partial mastectomy as it is just used in this scenario as a place holder.

I did find the CPT Assistant article that states to use the 19499, Year: 2009; Issue: December; Pages: 9-15; Title: Bonus Feature; however, my question is whether it is really billable or not since it's in the same incision site as the partial mastectomy. It is standard of surgical care when MammoSite is planned and it included?

A. Farmer, CPC​
 
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