# ULTRASOUND-GUIDED CORE BIOPSY WITH CLIP PLACEMENT -Axillary



## chembree

ULTRASOUND-GUIDED CORE BIOPSY WITH CLIP PLACEMENT AND UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM RIGHT AXILLA 10/22/2012.

INDICATIONS:  Enlarged right axillary lymph node. Mammogram was otherwise unremarkable.

TECHNIQUE:  After the patient identification and site to be biopsied were confirmed with the patient and the films, the risks, benefits and alternatives of the procedure were discussed with the patient and informed consent was signed. The abnormal axillary node was identified in the axilla and measured 2.4 x 1.4 x 2.0 cm. The cortex is asymmetrically thickened. A brief history and physical was performed and placed on the patient's chart. The area was prepped and draped in the normal sterile fashion. Timeout was called. The skin and subcutaneous tissues were anesthetized with 1% lidocaine. A small dermatotomy was made and a 14-gauge core biopsy needle was advanced into the breast under ultrasound guidance. Four passes were made through the thickest part of the cortex. The samples were placed in formalin and labeled with the patient's name. The name and site were confirmed with the patient prior to sending the sample to pathology for review. A clip was then placed alongside the lymph node that was biopsied. The needle was removed and hemostasis was achieved with manual compression. The patient experienced no immediate complications during the procedure. She was given aftercare instructions and the procedure for receiving her results was discussed. She was taken for unilateral digital diagnostic mammogram and left the department in stable condition.

UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM 
FINDINGS:  Unilateral digital diagnostic mammogram shows scattered fibroglandular densities. A clip is seen just anterior to the enlarged lymph node identified mammographically.

IMPRESSIONS:  Successful ultrasound-guided core biopsy of abnormal right axillary lymph node.
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Axillary node biopsy 38505
clip??? 19295 is an add-on and can only be billed with 10022,19102-19103. So how do I code the clip? 
Ultrasound 76942-26
Digital mammo G0206-26-RT


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## amandahollis80

*WHICH UPC code????*

Our office is having the same discussion. We place clips when we biopsy the axillary tail (lymph node). We are trying to decide what is the correct UPC code to use. Is it geared toward the lymph node or the breast. I am leaning more toward the breast UPC because that is the intent when the diagnosis is breast cancer. We know that 19295 can not be used. The question is which UPC code is appropriate 19499 or 38999? 


 We posted this question on the RBMA website and are still waiting for a response: What is the correct UPC for a clip placement following a breast biopsy of a lymph node in the axillary tail of the right breast, 19499 or 38999?

Thanks


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## chembree

amandahollis80 said:


> Our office is having the same discussion. We place clips when we biopsy the axillary tail (lymph node). We are trying to decide what is the correct UPC code to use. Is it geared toward the lymph node or the breast. I am leaning more toward the breast UPC because that is the intent when the diagnosis is breast cancer. We know that 19295 can not be used. The question is which UPC code is appropriate 19499 or 38999?
> 
> 
> We posted this question on the RBMA website and are still waiting for a response: What is the correct UPC for a clip placement following a breast biopsy of a lymph node in the axillary tail of the right breast, 19499 or 38999?
> 
> Thanks



Thanks Amanda. These are the same two codes I was debating. I know medlearn Q&A explained to use 19499 for clip placements post cyst aspirations but I also can't find any guidance on the axillary.


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