# Stereotactic breast biopsy - sterile fashion



## debaloia (Apr 13, 2009)

Dr lists procedure performed as:  1.  Assistance provided to mammo tech Marie and stereo localization.  2.  Calculation of stereo coordinates  3.  Stereotactic biopsy of left breast  4.  Placement of marker clip

The description of the procedure is:  pt identified in the preoperative holding area by wristband and conversation, brought back to the mammography suite, placed prone on the Lorad mammotome table with the left breast in the medial to lateral approach.  Assistance was provided to the mammo tech and stereo localization of the medial inferior quadrant mass.  Stereo views were obtained.  There appeared to b e better display on the scout, plus 15 images were used to calculate the stereo coordinates which were then transferred onto the mammotome stage.  The skin was prepped and draped in a sterile fashion.  ___position was copiously infiltrated with the 1% Lidocaine containing Epinepherine.  Four-quadrant infiltration was done peripherally.  A curciate incision was made.  Needle placement was advance to 0, -2 mm and pre-fire followed by firing of the needle and post-fire views were obtained.  Multiple cores were then obtained from this area and post biopsy mammogram indicated presence of a dense lesion with some microcalcifiations suspected to be biopsied.  Havindg confirmed the presence of the lesion a marker clip was placed using manufacturer's recommendations.  The needle was withdrawn and the the marker clip position was confirmed.  

My question is how to bill the radiological procedures?  Would you agree with cpt 19103,77032-26, 77012-26,19295?

Thanks in advance for any insight.


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## msncoder (Apr 14, 2009)

*Stereotactic breast biopsy*

77031-26, 19103, and 19295 is correct. I do not see any documentation for CPT 77012 to be charged, am I overlooking it?
Anita Elder, CIRCC, CPC, RCC
radcoder4msn@yahoo.com


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## debaloia (Apr 15, 2009)

I get hung up on his number1 and 2 assistance provided to mammo tech Marie and sterolocalization is that a 77031 or 77032 and the Calculation of Coordinates I do not really know how that is done -or what code that refers to.  Please let me know how I should be thinking when reading the cpts and op note. 

thanks!


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## luz.buenaventura (Apr 15, 2009)

i would add the post mammogram 77055.
19103,77031-26, 19295


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## msncoder (Apr 16, 2009)

As long as it is performed under stereotactic guidance then the only code you could use for guidance would be 77031. If they say that guidance was performed under mammography then you would charge 77032.....u/s guidance would be 76942.....MR guidance would be 77021....CT guidance (no mention of stereotactic) would be 77012.....fluoro guidance would be 77002. 
I attached a reference from the 2009 Medlearn Breast Procedure Coding Guide that lists the guidance codes. Hope this helps!


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## Zina (Apr 21, 2009)

In my opinion, the only codes to be billed by the surgeon are 19103 and 19295. If the surgeon isn't performing the mammo or interpreting the mammo, he can not bill for mammo codes. That's how it's done at our facility. The tech does the mammo's and the radiologist interprets.


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