# Breast Biopsy modifier and U/S questions



## MichelleAKing (Aug 8, 2018)

I have a patient who had a breast biopsy done and is back again for re-excision during the postoperative period as the doctor did not believe he got it all. My first question is should I append a -58 to this second attempt? Secondly, is it appropriate to code CPT 76998 (ultrasound guidance; intraoperative) with the breast biopsy (19120), and if so should a modifier be used? I realize that CPT code 76998 is a component of column 1 code 19120, but I have looked on Selectcoder and it's showing me that they can both be used with the appropriate modifier. Any thoughts would be greatly appreciated.
Thank you!
Michelle King CPC


----------



## RyanRaichCPC (Aug 9, 2018)

Hello Michelle.  Yes, I would definitely append either a -58 or -78 if the return to OR was unplanned.  As far as the 76998, My Coders Desk Reference makes no mention of UltraSound being included.  I would say bill it out without a modifier, unless your doc is only doing the professional component of the imaging and then I would append -26.  I hope this helps!


----------



## tcooper@tupelosurgery.com (Aug 16, 2018)

*Breast Biopsy*

Good Morning..We use the 58 Modifier when a patient is taken back to the operating room for a more extensive procedure. Also, please check to see if the patient did not have a partial mastectomy, lumpectomy the 2nd time. I have attached an article from AAPC. Hope this helps.
Teresa Cooper, CGSC


Mastectomy or Excision? Consider the Margins

By John Verhovshek 
 In Coding 
 August 29, 2016 
 No Comments 


Mastectomy or Excision? Consider the Margins  
When deciding between 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions and 19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy, search the documentation to determine whether a margin of health tissue was removed, along with the breast mass.

If the surgeon removes only the mass, with little or no margin, look first to 19120. Report one unit of 19120, per incision (not per mass removed). CPT® Assistant (March 2005) instructs:


…code 19120 should be reported for each of the separate excised areas since it includes one or more lesions through the same incision. However, if excisions are performed on different areas of the breast through separate incision sites, code 19120 should be reported for each incised area. Modifier 59 [Distinct Procedural Service] should be appended to the second procedure code.

For more extensive resection performed for gynecomastia [benign enlargement of breast tissue], report 19300 [Mastectomy for gynecomastia]” (CPT® Assistant, March 2014). Claim 19300 for male patients, only, “as gynecomastia is a male condition” (CPT® Assistant, Feb. 2007).

When the surgeon removes a breast lesion with a margin of healthy tissue, look to 19301. CPT Assistant (Feb. 2007) instructs:


Partial mastectomy procedures describe open excisions of breast tissue and include specific attention to adequate surgical margins surrounding the breast mass or lesion. In a partial mastectomy, a larger amount of breast tissue and some skin are removed with the tumor. This also includes removal of the lining over chest muscles below the tumor. This surgery is usually performed for stage 1 and 2 tumors. This code is reported also for the performance of a lumpectomy where the tumor and a small amount of surrounding tissue are removed.

In these cases, the mass is suspected or known to be malignant, and the margin of health tissue is removed to ensure that the entire malignancy has been excised.


----------



## nlbarnes (Sep 27, 2018)

Does the provider need a license/cert to perform US?  Our vascular surgeons have them for their procedures.  Thanks...


----------

