Coding Corner: Test Yourself: Breast Procedure Coding

Solve these 3 common dilemmas to sharpen your skills

Choosing breast procedure codes isn't always an easy task. Try your hand at these key questions - knowing the answers will keep your coding sharp and your documentation flawless.
Question: The surgeon performed a breast biopsy, followed by a radical mastectomy. How should I select the right breast biopsy codes? Is the biopsy bundled with the mastectomy?
Answer: Depending on the tissue excised and the excision method, you could be dealing with any of these breast biopsy-related codes:
 
19000* - Puncture aspiration of cyst of breast
 
19100* - Biopsy of breast; percutaneous, needle core,  not using imaging guidance   [separate procedure]
 
19101 - ... open, incisional
 
19102 - ... percutaneous,  needle core, using imaging  guidance
 
19103 - ... percutaneous,  automated vacuum-assisted or  rotating biopsy device, using  imaging guidance
 
19120 - Excision of cyst, fibroadenoma, or other benign or malignant tumor,  aberrant breast tissue, duct  lesion, nipple or areolar  lesion (except 19140), open, male or female, one or more lesions
 
19125 - Excision of breast   lesion identified by preoperative placement of radiological  marker, open; single lesion.

To determine if the biopsy is bundled into the mastectomy (and not separately billable), consult the National Correct Coding Initiative (NCCI) edits. NCCI does bundle the biopsy code into the mastectomy code, but because the indicator assigned to the bundle is "1," you can bill them individually in certain circumstances. Judge by when the biopsy was performed, says Tray Dunaway, MD, FACS, a general surgeon in private practice in Camden, S.C. "If they're done as separate procedures in the OR [operating room] at the same time, you can't separate them," he says. "But if you do the biopsy now, wait for the results, and do the surgical procedure another day," and the biopsy led to the decision to perform surgery, you can bill for it separately.
Question: How should I code a lumpectomy? How does it differ from a partial mastectomy?

Answer: Identifying the proper code for a lumpectomy is easy: It's 19120 (Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion [except 19140], open, male or female, one or more lesions). But choosing a code for a partial mastectomy isn't as clear-cut. And if it's not clear on the chart, you need to know exactly how much the doctor cut.
Numerically, the surgeon generally needs to remove at least 25 percent of the patient's breast before you can call it a "partial mastectomy." But it's OK to use your judgment. Use the "25 percent" as a guideline, and compare the size of the lump [...]

- Published on 2003-10-08