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Biopsy with US guidance

  1. #1
    Default Biopsy with US guidance
    Medical Coding Books
    Is 76942 billable with 19102? Or is the guidance bundled into 19102?

    Thanks for any help!

  2. Default
    If it is ultrasound guidance you can. Guidance is not bundled into breast bx.

  3. #3
    Default biopsy with guidance
    I would say it's bundled:
    19102 has the wording "with imaging guidance" in the description so it's not separately reportable.

  4. #4
    76942 and 19102 appear to be billable together. There are no conflicting edits on them being billed together and if you look at encoder it crosswalks you to the guidance codes in addition to the biopsy.

  5. #5
    Default biopsy
    Coding and reporting image-guided breast biopsies

    The Centers for Medicare & Medicaid Services (CMS) recently published instructions for coding and reporting percutaneous image-guided breast biopsies in program memorandum (PM) AB-02-128.

    According to the PM, Medicare covers services provided for percutaneous image-guided breast biopsies. The image guided systems may be either ultrasound or stereotactic. Coverage is provided for a radiographic nonpalpable abnormality that is graded based on the Breast Imaging Reporting and Data System (BIRADS) as probably benign, a suspicious abnormality, or an abnormality. Medicare will also cover palpable lesions that are difficult to biopsy using palpation alone.

    The applicable CPT codes listed in this PM for facility reporting are:

    · 19102, percutaneous needle core, using imaging guidance

    · 19103, percutaneous automated vacuum assisted or rotating biopsy device, using imaging guidance

    · 10022, fine needle aspiration; with imaging guidance

    NOTE: For imaging guidance performed in conjunction with 19102, 19103 see codes 76095, 76096, 76360, 76393 and 76942.

    This is from coding clinic, so I stand corrected. They are separately billable. Thanks for making me check again!

  6. #6
    whew...I was thinking I'd have to let some people know that they've been billing them wrong! good to know they're good

  7. Default
    CPT 76942 can be billed with 19102.It is not a bundled procedure.

  8. #8
    I have been coding for radiology and i do bill 76942 and 19102 together. It has never been denied so far.

  9. Default CPT 76942 and 19103
    If the hospital owns the portable ultrasound machine - and the surgeon does the breast biopsy in his office can he bill for the 76942 plus the 19103. I know it is possible in the hospital setting but not sure if the surgeon can from his office since the equipment is not owned by that facility


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