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Breast Bx : 19102

  1. #1
    Question Breast Bx : 19102
    Medical Coding Books
    I need help with billing 19102 with a 76 mod. Ok, how many times's should a provider bill this code if he is only entering 1 lesion and taking multiple specimens. He is not documenting how many specimens exactly, but he wants to bill 19102 x 5 with a 76 mod.
    According to what I have read, the provider has to take at least 5 specimens in order to send for an adequate specimen. This needle (valcora) does it from 1 lesion. So here is the question:
    Is it correct to bill 19102 with 5 units or 5 x consecutively for each needle core taken or should I bill 19102 with 1 unit indicating at least 5 specimens were taken? This is confusing?

    This is all I have found so far: In 19102, under image guidance, the physician inserts a large gauge (e.g., 14 gauge), hollow core biopsy needle through the skin of the breast and into the suspicious breast tissue. The physician takes five or more cores of tissue to obtain a sufficient amount of tissue for diagnosis.

  2. #2
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    Quote Originally Posted by blackiez1 View Post
    I need help with billing 19102 with a 76 mod. Ok, how many times's should a provider bill this code if he is only entering 1 lesion and taking multiple specimens. He is not documenting how many specimens exactly, but he wants to bill 19102 x 5 with a 76 mod.
    According to what I have read, the provider has to take at least 5 specimens in order to send for an adequate specimen. This needle (valcora) does it from 1 lesion. So here is the question:
    Is it correct to bill 19102 with 5 units or 5 x consecutively for each needle core taken or should I bill 19102 with 1 unit indicating at least 5 specimens were taken? This is confusing?

    This is all I have found so far: In 19102, under image guidance, the physician inserts a large gauge (e.g., 14 gauge), hollow core biopsy needle through the skin of the breast and into the suspicious breast tissue. The physician takes five or more cores of tissue to obtain a sufficient amount of tissue for diagnosis.

    The physician has to do 5 or more. You are right. He can't bill it 5 times. He can only bill it with 1 unit - he can charge whatever he'd like, but as long as he is contracted, he will get the allowed amount. As for Medicare, they'll pay you around $100 for facility. So that's what he'll get for 5 specimens - and no you don't have to bill it indicating the 5 specimens, that should be in the op note.

    Now you can also bill 19295 (for the localization clip) if you do this with the biopsies. It's an add on code. The allowable for it I think is somewhere around $90 off the top of my head - so that can make up for 19102 X 5 a little

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