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Old 07-31-2008, 07:46 PM
Roni K Roni K is offline
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Default Breast lesion excision with markers

The physician excises 2 breast lesions with 2 breast localization needles, using only one incision. I know that the verbage for 19125 specifies "single lesion" and 19126 is used for "each additional lesion," but I think that applies to 2 lesions in separate areas of the breast. I would like to uses 19125, 19290, and 19291. The other coders in my office think it should be 19125, 19126, 19290, 19291.

Any thoughts?
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Old 08-01-2008, 12:04 AM
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Quote:
Originally Posted by Roni K View Post
The physician excises 2 breast lesions with 2 breast localization needles, using only one incision. I know that the verbage for 19125 specifies "single lesion" and 19126 is used for "each additional lesion," but I think that applies to 2 lesions in separate areas of the breast. I would like to uses 19125, 19290, and 19291. The other coders in my office think it should be 19125, 19126, 19290, 19291.

Any thoughts?
Hi,

The answer lies in the following CPT assistant.

March 1998 page 10

Coding Consultation
CPT Assistant, March 1998, Volume 03, Issue 8, page 10
Integumentary System, 19125, 19126 (Q&A)
Question
A patient has a breast lesion excised from her left breast and 2 breast lesions excised from the right breast, all 3 lesions with wire localization prior to excision, how would my physician report these services?
AMA Comment
From a CPT coding perspective and in the absence of a specific operative note, if a lesion identified by preoperative placement of a radiological marker is excised, then CPT code 19125, Excision of breast lesion identified by preoperative placement of radiological marker; single lesion, would be reported for the first lesion. If more than one lesion identified by preoperative placement of a radiological marker is excised, then code 19126, Excision of breast lesion identified by preoperative placement of radiological marker; each additional lesion separately identified by a radiological marker, would be reported for the excision of each additional lesion.
In this example, if a lesion identified by preoperative placement of a radiological marker is removed from the left breast and 2 lesions identified by preoperative placement of a radiological marker are removed from the right breast, code 19125 would be reported for the lesion on the left breast. CPT code 19125 and 19126 would be reported for the two lesions that were excised on the right breast. It is important to note that the modifier -51, Multiple Procedures, should not be appended to code 19126 as it is an add-on code. As stated in CPT guidelines on page 53 of the 1997 CPT book, add-on codes are exempt from the multiple procedure concept as they are not reported as stand-alone codes.

Hope you get the answer.

Thank You
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Amit Joshi MSc,CPC,CPC-H
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Old 08-05-2008, 07:10 PM
Roni K Roni K is offline
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HI. I read that earlier, but I believe that they are referring to two distinct lesions in two separate areas of the breast. This is a case where the lesions are virtually contiguous but there are two separate markers. There is only one incision. I don't think that a physician should be paid for 19125 and 19126 if there is only one incision. I may be reading too much into it, but my gut tells me that if it's one incision and one excision - then it's 19125.

Any thoughts out there?
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Old 08-06-2008, 08:45 AM
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I would code the 19125 and the 19126 because of this statement within the CPT assistant:

"If more than one lesion identified by preoperative placement of a radiological marker is excised, then code 19126"

It appears by what you have written that two markers were placed therefore justifing both codes. It does not mention that it needs to be two incisions.

just my two cents
Mary
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