Anesthesia Coding Alert

Question: Which diagnosis codes support medical necessity or medical indications for billing 76095?

Alabama Subscriber
 
Answer: Common diagnoses for 76095 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) include 239.3 (Neoplasms of unspecified nature; breast),  610.0 (Solitary cyst of breast), 611.71 (Mastodynia), 611.72 (Lump or mass in breast), or V16.3 (Family history of malignant neoplasm; breast). The lumpectomy might require anesthesia, but physicians often localize the lesion stereotactically without anesthesia, so justifying medical necessity could be difficult. Check the carrier's policy or your local medical review policies to determine which diagnoses they list in conjunction with this procedure and which services it typically includes.