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Thread: Stereotactic breast question

  1. #1

    Default Stereotactic breast question

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    Not sure what to do with this one. Pt presented for stereotactic breat bx. Pt was placed on the table, breast suspended through the aperture. Multiple attempts were made to localize the abnomality. The pt has very small volume of breast tissue and the localizing coordinates were not suitable for stereotactic bx. The Dr insist there is a code for a aborted procedure. Should I use the modifier 53? If so on which code? 19103? the 19295 is a add on code should i use that also?
    Thank you
    Marie

  2. #2
    Join Date
    Apr 2007
    Location
    Johnson City
    Posts
    202

    Default

    What about billing just for the stereotactic guidance, code 77031 with the appropriate modifier, 26, TC... It sounds like the stereotactic guidance was performed, but the biopsy was not.

    Melissa-CPC

  3. #3

    Default Cpc

    For the billing/reimbursement point of view, I would agree to use modifier 53 on 19103. The procedure was performed but interrupted. if you bill using 26/TC (unbundle the procedure). If you use -53 and provide documentation you should be able to get partial/full reimbursement. Documentation will be the key, (how much time was spent, complexity and reason for interruption)

  4. #4

    Default Manon, CPC

    For the billing/reimbursement point of view, I would agree to use modifier 53 on 19103. The procedure was performed but interrupted. If you use -53 and provide documentation you should be able to get partial/full reimbursement. Documentation will be the key, (how much time was spent, complexity and reason for interruption)

  5. #5
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Default

    I am with mjewett on this one.
    I see this scenario quite often, and do not code the "biopsy" at all in this case.
    The attempt to localize the lesion was done (Radiology code), but the biopsy itself was not started. Only the Radiology service should be billed.
    If a modifer could be used, I don't think "53" would be appropriate based on the description of that modifier.
    Karen Maloney, CPC
    Data Quality Specialist

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