Hello -

I welcome any and all opinions on the coding of this scenario:

Patient has stereotactic breast biopsy with clip placement on 4/25/10. Pathology returns as breast cancer.
Patient has post-op visit 4/30/10, and the breast is ultrasounded using physician-owned portable ultrasound equipment to find the clip. This image is stored in the portable ultrasound machine.
Patient returns to the OR 5/15/10 for formal excision of the cancer. The physician brings his own portbale ultrasound machine to the hospital OR (the same one used during the post-op visit). Another ultrasound of the breast is performed to locate the clip. Excision proceeds.

Here's the question: The reason the physician ultrasounded the breast at the post-op visit was so that if they needed to pull up the image in the OR (because they couldn't find it in the OR), it would be available to them. My question is: when should the ultrasound be billed? At the post-op visit or at the time of the formal excision?

Thanks in advance!