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19125 vs 19301

  1. Default 19125 vs 19301
    Medical Coding Books
    What is the difference between 19301 and 19125? I was told to use 19301 or 19125 depending if quandrant of breast is used or if excision is to get clear margins for a patient diagnosed with CA, otherwise use 19125. Sometimes I get repors that say breast lumpectomy or breast lumpectomy with needle localization. Is it then they say needle localization, I use 19125?

    operation: A curvilinear incision was made at the site of the needle localization, dissection carried down to the sub q tisue. Immediately we began to raise both superior and inferior flaps. Using Metzenbaums. we continue dissecting with metzenbaums. since this lesion was very deep and was very close to the chest wall, we continued dissecting until we now came upon more of the wire or the localization needle. We continued dissecting until we came upon the tip of it then we dissected the tissue all the way around the needle and the tip of the needle.


  2. #2
    East Stroudsburg, PA
    CPT 19125 the lesion is identified by preoperative placement of radiological marker.

    19301 is a partial mastectomy or lumpectomy. There is also NO radiological marker placement.
    ~Rebecca, CPC, COSC, CPC-I

    "To the world you may be one person, but to one person you may be the world" ~Anonymous

  3. #3
    Vancouver Washington

    we used to have problems deciphering between the two codes as well. We use 19301 when the doc is obtaining new margins, so even if the wire is present and the doc resects the wire, but in the process is obtaining new clean margins, we use 19301. If the doc just removes the the wire specimen, but pays no attention to margins, then we use 19125.

    I think this is right....but who knows!!!

    Jaime, CPC
    Jaime Wicklund, CPC

  4. Default reply to Jamie
    So this should be a 19125? " we continued dissecting until we came upon the tip of it then we dissected the tissue all the way around the needle and the tip of the needle". This sounds like he removed the wire and the tissue around it. I don't see anything about margins. What do you think?

  5. #5
    Columbia, MO
    The coders desk reference states the 19125:
    the physician uses radiologic markers to ID breast tissue to be excised for biopsy.....

    the 19301:
    the physician excises a breast tumor and a margin of normal tissue....

    So I think the question is was this procedure performed to obtain a sample for biopsy or was it definitive to remove a mass?

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