# 19125?



## codedog

I dont know why I am uncertain of this but is this  cpt code 19125 ?


PREOPERATIVE DIAGNOSIS:	Nonpalpable right breast mass.

POSTOPERATIVE DIAGNOSIS:	Nonpalpable right breast mass.

PROCEDURE PERFORMED:	Right needle-localized ultrasound-guided right breast biopsy.

ANESTHESIA:	General.

ESTIMATED BLOOD LOSS:	Minimal.

CLINICAL HISTORY:  A female with a nonpalpable right breast mass. Percutaneous needle biopsy had previously been obtained, but there is a question as to whether or not lesion in question was adequately biopsied.

PROCEDURE IN DETAIL:  After the patient went to radiology and had the needle placed, the patient was brought into the operating room.  The right breast was prepped and draped in a sterile fashion.  A curvilinear incision was made in the lower outer quadrant of the breast about 2 cm away from the edge of the areola.  The electrocautery was used to dissect through the subcutaneous tissue.  The needle, which had been placed through the border of the areola was exteriorized through the incision.  The area in question was then grasped with a Lahey clamp.  Electrocautery was used to excise the area, which had been marked by the needle.  All of the margins were grossly negative.  The specimen was marked for orientation and sent to the pathologist.  The wound was irrigated with normal saline.  It was inspected and found to be hemostatic.  The subcutaneous tissue was closed with interrupted 3-0 Vicryl suture and interrupted 3-0 nylon was used to close the skin.  A total of 10 cc of 0.25% Marcaine with epinephrine were injected for local anesthesia into the skin and breast parenchyma.  The patient tolerated the procedure well.


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## BABS37

19102 and 76942 is what I would code.


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## jmcpolin

19125 sounds like exactly what they did.


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## jmcpolin

19102 is a needle biopsy they did an excision it looks like to me.


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## codedog

heres what I found, so going  with 19125

When a physician excises an entire tissue mass for biopsy reasons, it's considered an excisional biopsy, but the CPT code for excision of breast lesion is assigned instead of a "biopsy" code. This is an important consideration because in many cases, the physician may document "breast biopsy" as the name of the procedure, when in fact, a breast lesion excision was actually performed. It's essential that the coder carefully review the operative report to determine the extent of the procedure. CPT code 19120 (Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (, open, male or female, one or more lesions) should be assigned. Note that the code may be used for either male or female patients and that the code should be assigned only once, regardless of the number of lesions excised through the same incision. According to CPT Assistant, April 2005, p. 13, if multiple separate incisions are made to remove multiple breast lesions, code 19120 may be reported more than once. Assign ICD-9-CM code 85.21 (Local excision of lesion of breast) for this service. 

The other procedure that involves excision of an entire lesion is one that uses a localization technique, whereby a needle or clip is placed into the breast lesion preoperatively to assist in exact identification of the affected suspicious tissue. Assign code 19125 (Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion) for the excision of the lesion that was identified with a radiological marker. Note that add-on code 19126 (each additional lesion separately identified by a preoperative radiological marker) is available when more than one needle or clip is used to identify more than one lesion. Note that a separate code for the placement of the localization device should also be assigned. These codes include 19290 (Preoperative placement of needle localization wire, breast), add-on code 19291 (each additional lesion) and 19295 (Image guided placement, metallic localization clip, percutaneous, during breast biopsy). Coding staff in hospitals should ensure that the radiology department is


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## BABS37

I was looking at the PROCEDURE PERFORMED:	Right needle-localized ultrasound-guided right breast biopsy, which would be 19102 and 76942. According to his note, that doesn't sound like what he did but I wouldn;t code 19125 either- there's no mention of a marker in his note. I would go with 19120. Sorry for the confusion.


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## BABS37

Oh never mind. I see where the needle was placed. He threw me off with the percutaneous needle biopsy. Geeze, maybe you ought to send the note back and have it corrected bc what he did and what the procedure performed are clearly not the same.


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## codedog

I work st an ASC and  booking was schedule as 19101 biposy of breast, but I   see that the specimen was excised ,but I dont see where it states Radiological marker ?Is it where it stated electrocautery  was used to excise area, which had been placed by the needle, is the needle the marker ?


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## BABS37

It doesn't necessarily have to say radiological marker. It can be a marking clip or a needle or I have even seen localization clip used in some of my reports. Does that help?


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## codedog

Yes, thanks  Brooke, also I talked to scrub  nurse who was in this case and said that a wire was done and she  read the report with me and  the needle is  refer as the wire , she will tell the  physician  next time to be more clearer. Thanks


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## BABS37

Oh good! Sorry I didn't read the report correctly to begin with! Probably would have saved a lot of confusion but sometimes I get in a hurry and try to multi-task


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## codedog

no problem  , glad  you responed ,  sometimes b different answers makes  it more of a challenge to understand it more ,Thanks again


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