General Surgery Coding Alert

Although breast procedures are common, they still present coding challenges. These procedures can vary widely (from punch biopsy to complete mastectomy), as can the methods and technology used to diagnose and treat breast tumors, masses or other lesions. Coding can be simplified, however, by answering the following questions:
 
1. The surgeon performed a breast biopsy followed by a modified radical mastectomy. How do I select the right breast biopsy codes? Is the biopsy bundled with the mastectomy?
 
Many biopsy codes are bundled with lumpectomy and mastectomy codes in the national Correct Coding Initiative (CCI). But this does not mean they cannot be billed together, says Elaine Elliott, CPC, an independent general surgery coding and reimbursement specialist in Jensen Beach, Fla.
 
The CCI edits do not apply when the biopsy is diagnostic, i.e., the biopsy leads to the decision to perform the larger procedure. If the results of a biopsy are positive, for example, the surgeon may perform a lumpectomy or mastectomy. In such cases the biopsy is not included in the lumpectomy or mastectomy and is separately payable. But if the surgeon -- having previously performed a biopsy -- plans to remove a malignant mass but wants a confirmatory biopsy, this second biopsy is a component of the larger procedure and may not be billed separately.
 
Breast biopsies differ depending on the kind of tissue excised and the method used. Applicable codes include:
 
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
 
88170 -- fine needle aspiration; superficial tissue (e.g., thyroid, breast, prostate).  
The first step when coding is to determine if the biopsy is bundled with the larger excision code. For example, an excisional biopsy (19120) returns positive. After conferring with the patient, the surgeon performs a modified radical mastectomy, 19240 (mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle).
 
CCI bundles 19120 to 19240. The edit includes a 1" indicator however which means it can be bypassed by appending a modifier under certain circumstances. For instance [...]