Wiki Wire localization separately reportable?

[hsmith67]

Any assistance on resolving a debate is greatly appreciated.
Surgeon is placing wire localization in the OR with ultrasound or stereotactic guidance prior to beginning any other procedure (biopsy, lumpectomy, mastectomy). After completing the wire localization the surgeon then begins and completes the biopsy/lumpectomy/mastectomy as needed.

There is guidance from AAPC: CPT® Assistant (Vol. 31, Issue 5) indicates that percutaneous breast localization devices that are “placed intraoperatively (i.e., during the skin-to-skin portion of a mastectomy procedure)” are “not … separately reportable.”
Caveat: The same CPT® Assistant issue notes that if a device is placed in a procedure separate from the mastectomy, usually prior to performing to the 19301/19302 procedure, the device placement is separately reportable. In that case, you could report 19281 (Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance).

ACS offers this guidance:

The surgeon percutaneously placed a lesion marker in the breast using ultrasound guidance and then performed an open excisional biopsy. How is this procedure reported?​

Report both code 19285, Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance, and code 19125, Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion. Depending on payor preference, modifier 51 would be appended to 19285.

The debate centers around not billable as wire was "placed intraoperatively" (and not reportable per AAPC guidance) as well as the ACS example is for excisional biopsy and not applicable to lumpectomy/mastectomy that have higher RVU's and would therefore include the wire localization.

Thanks for weighing in.
Hunter Smith, CPC

 

[tcooper@nmhs.net]

Hunter,
Our Surgeons do Breast Lumpectomies. First they take the patient to the Stereotactic Room, they localize the area and then place the localization wire. They do a seperate dictation for this because when they are finished they carry the patient to the Operating Room and there they do the lumpectomy. I think the confusion comes in to play because the Radiologist is not doing this Wire Localization but the Surgeon is. Also, there should be a Radiology Report stating that the Surgeon did the localization. So we code 19301 and 19283. We are paid for these but sometime you have to fight for them..