# Breast needle localizations



## ldolyak (Jan 10, 2008)

Can someone help me when a Breast lumpectomy with needle localization is performed which code is correct the 19125 or 19301.  There is no documentation anywhere to support using one or the other.  Thanks


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## mmelcam (Jan 11, 2008)

I would use 19125


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## hpycoder (Jan 15, 2008)

I Would Use 19301 Depending On The Size Of The Lump Removed. The
Payment Would Be Higher From Ins. Company Assuming This Is Not
A Self-pay Patient.


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## AWARDEN (Jan 15, 2008)

I have been told that you can use 19301 if a quadrant of the breast was removed or if you are excising to get clear margins for a patient diagnosed with cancer.  If you don't meet the above criteria I have been told to use 19125.


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## sundaey (Mar 6, 2008)

I've used 19125 if the doc uses the clips and doesn't mention clear margins. If he does say that he took care to get margins, then I would use 19301. Hope that this helps.


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## Tvitolo (Oct 23, 2008)

*19125 and 19301*

If a 19125 specimen was sent to pathology and from that result surgeon has to perform a 19301.   Can you use a modifier 58 and document both codes?


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## mbort (Oct 23, 2008)

the 19125 bundles with the 19301 per the CCI edits.


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## magnolia1 (Oct 23, 2008)

If 19125 is performed initially, and the surgeon subsequently goes back to get "margins", I do not use 19301. (the description of that code in Coders' Desk Reference states the lump/ mass is removed  a margin of  healthly tissue).

If subsequent surgery is done to remove additional tissue (margin), 
I use 19120 (excison of breast tissue).

Karen Maloney, CPC
Data Quality Specialist


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## aguelfi (Oct 24, 2008)

The problem I run into is 19125 specifies w/ radiology markers, and 19120 doesn't.  My doctor doesn't always include this in his documentation but it's closer to what he actually does.  I need to talk to him, but he's not one to listen well.  Any suggestions?


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## cmartin (Nov 17, 2008)

If, during the initial procedure, seemingly normal tissue is taken in an effort to get clear margins for either invasive cancer or DCIS, I use 19301.  If only the abnormal tissue itself is being removed, I use 19125 (or if no localization, 19120).  In either case, if a later return is required to get additional tissue for clear margins on CA or DCIS, I use 19301, with the 58 modifier if, as is usually the case, the return is w/in 90 days.  I don't understand the point about the desk reference definition - if it's that the "mass" - or most of it - has already been removed, then 19120 seems LESS appropriate to me.  Its actual CPT definition states cyst/tumor/lesion/aberrant breast tissue, whereas 19301 just states partial mastectomy, followed by some examples in parentheses. (I always have to put a note in my book: e.g.=for instance; i.e.=that is).  So if most or even all of the additiional tissue removed turns out to be "normal", I can't see where 19120 is better than 19301.  Just my opinion.
C.Martin CPC-GENSG


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