# Ultrasound localization needle breast mass



## codedog (Jan 20, 2012)

Please clarify something for me .Another coder and I have a disagreement on this and we need your help. 
CPT code  19102 states Biopsy of breast, percutaneous ,needle core , using imaging guidance

Cpt  code  19125  states Excision of breast identified by preoperative  placement of radiological marker 

Now we have patients come in our ASC and have an excision of breast mass .Sometimes they use ultra sound  need- loc  guided wire . 

Other coder thinks it should be 19102, because of he ultrasound , but I say different. It should be 19125 because physcian excised whole mass not a biopsy. 19125 states that its a placement of a radiological marker  is used for nonpalpable lesions that have been identified  on a mammogram or ultrasound of the breast . 

Here is one of the reports 
PREOPERATIVE DIAGNOSES:	Breast mass left breast, status post mastectomy left breast, status post DIEP reconstruction left breast.

POSTOPERATIVE DIAGNOSES:	Breast mass left breast, status post mastectomy left breast, status post DIEP reconstruction left breast.

PROCEDURE PERFORMED:	Excision of breast mass with needle localization.

OPERATIVE PROCEDURE:  The patient had had a DIEP reconstruction of the left breast and had noted a firm area on the breast.

Because of the mass, it was not particularly well defined, we did an ultrasound and the mass was seen on ultrasound and a localization needle was placed by the radiologist.

The patient was then taken to the operating room placed under adequate general endotracheal anesthesia.  The breast was prepped with Betadine and draped in a customary fashion.  An incision was made just superior to the wire and the incision was carried down through the skin and subcutaneous tissue.  The wire was traced down to a firm mass, which was excised with the wire intact.

The mass was then submitted to the pathologist for permanent section.  The wound was then closed in layers with 4-0 Vicryl and 4-0 Monocryl.  The patient had sterile dressing applied and went back to recovery room in good condition having tolerated the procedure well.
 note breast mass  specimen-permanent


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## donnajrichmond (Jan 22, 2012)

19125.  Definitely not 19102.  19102 is a percutaneous needle biopsy.  An incision is not made (except possibly a tiny one to start the needle off) for 19102.  
In this case, they localized the mass, the radiologist placed a needle loc wire (he will bill for that separately), and then this doctor excised the mass.


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## codedog (Jan 23, 2012)

thanks donna


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