As discussed last month, new category III codes that could impact your interventional radiology coding services are now effective as of January 1, 2022. With these codes now active, interventional radiology providers and stakeholders should be aware of the scope of changes in place for the new year. New code 0644T mentioned in last month’s insight, has a significant amount of detail for correct coding and comprehension. By knowing the rationale, staff and coders can prepare for a successful year while safeguarding compliance.
Coding Inclusion
So, what do the breast biopsy codes include? Breast biopsy codes include the following components:
- the percutaneous biopsy
- placement of a localization device
- imaging of the biopsy specimen, and guidance.
Understand that guidance, localization device placement, and/or imaging of the removed specimen should not be separately coded when associated with a percutaneous biopsy.
It no longer matters whether the biopsy is performed using a rotating or vacuum-assisted device; instead, the code choice depends on the type of guidance. These codes may be used even when a localization device is not placed, or a surgical specimen is not x-rayed because the code description indicates “if performed.”
Frequently, a clip is placed at the biopsy site after a percutaneous biopsy. These clips can be seen under radiographic imaging and are placed in case other intervention is later required. The clip indicates the location of the biopsy site. Clip placement is included in the percutaneous breast biopsy codes when performed by the same physician at the same session.
Coding Rationale and Inappropriate Application
There are several types of guidance including:
- stereotactic
- ultrasound
- or magnetic resonance
For each type of guidance, there is a code for first lesion and another for each additional lesion. The “each additional lesion” code would be assigned for a second lesion biopsied using the same type of guidance, whether in the same or opposite breast as the first lesion.
Understand that it is not appropriate to report an initial lesion code with modifier 50 for biopsy of bilateral lesions using the same type of guidance. Coding would be the same if a single lesion is biopsied in each breast or if two lesions in one breast are separately biopsied using the same type of guidance. If bilateral lesions or two lesions in one breast are separately biopsied using different types of guidance, assign the appropriate “first lesion” code for each.
For example, if a lesion in the right breast is biopsied using ultrasound guidance, and a separate lesion in the same breast must be biopsied under MRI guidance, you would submit codes 19083 and 19085. However, if separate lesions in the left and right breast are both biopsied using ultrasound guidance, codes 19083 and 19084 would be reported.
| 19081 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance |
| +19082 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) |
| 19083 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance |
| +19084 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) |
| 19085 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance |
| +19086 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) |
Mammographic Guidance and Aspiration Biopsy
There is no longer a code for mammographic guidance for needle placement. If a percutaneous breast biopsy is performed under mammographic guidance, the unlisted surgical code 19499 should be assigned. Code 19499 also should be reported if CT guidance is used for a percutaneous breast biopsy.
| 19499 | Unlisted procedure, breast
Note that if a percutaneous breast biopsy is performed without imaging guidance, code 19100 would be appropriate. |
| 19100 | Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) |
So how is aspiration biopsy coded? Aspiration biopsy of the breast is coded using the appropriate generic FNA code (10021, 10004-10012). Note that coders sometimes have trouble deciding between an FNA and breast cyst aspiration (19000-19001). The FNA code would be assigned when the intent of the procedure was to obtain a sample of cells or fluid for diagnostic evaluation, even if the lesion was a cyst. Code 19000 is assigned if the intent was to drain a cyst, even if the aspirated material is sent to the lab for cytologic evaluation.
Explore more topics, crack through the complexity of interventional radiology, and master more coding through expert-infused tips by using our Essentials of Interventional Radiology Coding resource. Create success for 2022 and beyond.
Information source for breast biopsy statistic:
https://www.cbsnews.com/news/breast-biopsies-often-get-it-wrong/
