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Needle-Localized Breast Biopsy??

  1. Unhappy Needle-Localized Breast Biopsy??
    Medical Coding Books
    One of the physicians insists on using code 19125 "excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion" but her operative title states "needle-localized breast biopsy" and it says in there multiple times that a 4cm biopsy was taken. Can this justify a full excision code?

    Thank you so much,
    S. Guzman, CPC

  2. #2
    Kansas City, MO
    Im confused by your question...are you questioning because she uses the word "biopsy"? If so, it is possible that a "biopsy" could mean taking out an entire lesion ( especially if it is small like the above mentioned) is still removing a specimen for pathology, right? She could be right with her coding, but hard to say for sure until you review the op and/or speak with her.

  3. Default
    for bt bx w/ needle loc's we use 19125

  4. Default
    Thank you for your response!
    The op note makes the procedure sound like a biopsy only. It doesn't state that the margins were noted, or examined, and it doesn't state that the entire lesion was excised. Does just stating it was a biopsy justify an excision code? Or does it have to state that the full lesion was excised?

  5. #5
    Oops, please disregard this post.
    Last edited by LTibbetts; 12-14-2009 at 11:28 AM.

  6. #6
    It doesn't have to state that the entire lesion as excised but it would help. I used that code the other day for excision of microcalcifications and obviously, they couldn't all be removed with one excision. The word "excision" should be present somewhere on the op note, though, in order to back your code selection. See below

    CPT Lay Descriptions
    10021 - 19396 30000 - 39561 50010 - 59871 70010 - 79445 90281 - 99607
    20000 - 29907 40490 - 49906 60000 - 69990 80047 - 89356 0016T - 0198T

    19125-19126 (19125, 19126)

    The physician uses radiologic markers to identify breast tissue to be excised for biopsy. The physician makes an incision in the skin of the breast over the site of the lesion marked for excision by preoperative placement of a radiological marker. The lesion and marker are excised, without attention to obtaining clean margins. Bleeding vessels are controlled with electrocautery or ligated with sutures. A drain may be inserted into the wound. The incision is sutured in layered closure and a light dressing is applied. Report 19126 for each additional lesion identified by a pre-operative marker and removed during the same surgical session.

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