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Reader Question: Breast Biopsy

Question: One of our facilitys outpatients had a breast biopsy with pre-op placement of needle for localization. Our carrier indicated that listing the mammographic guidance for needle placement (76096) with the biopsy code (19101) on the claim is an error. Why? Is there a modifier we should be using? The codes we have for biopsy with pre-op needle placement for localization are: 19101 (open incisional) biopsy; 19290 (preoperative placement of needle localization wire, breast); 71020 (radiologic examination, chest); 76096 (mammographic guidance for needle placement, breast); and 76098 (radiological examination, surgical specimen).

Minnesota Subscriber

Answer: 19101 is the code for open, surgical biopsy. Per CCI edit 7.1, 19290 and 76096 are components of 19101, and therefore might be considered bundled into the biopsy service. However, 19102 is not listed in CCI 7.1 as a comprehensive code. Depending on whether the surgeon performed a needle or stereotactic biopsy, use code 19102 (percutaneous, needle core, using imaging guidance) or 19103 (percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance).

- Published on 2001-07-01

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