General Surgery Coding Alert

Watch out for the 77031 pitfall if the radiologist participates during surgery.

When coding for stereotactic breast biopsy procedures, you have to proceed cautiously or you could get your surgeon in hot water with payers and the radiologists he works with. Here's what you need to know before you start coding the next stereotactic breast biopsy procedure your surgeon performs.

When your surgeon performs a stereotactic breast biopsy, you first need to determine which biopsy code to report. You-ll have to decide between 19102 (Biopsy of breast; percutaneous, needle core, using imaging guidance) or 19103 (Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance) based on the documentation your surgeon provides.

How to choose: The difference between the two percutaneous breast biopsy codes is the device that your surgeon uses, says Pat McCullough, CPC, in the billing/coding department at Spring Ridge Surgical Specialists in Wyomissing, Penn.

You-ll use 19102 when your surgeon documents that he performed a biopsy using a device that he inserted into the breast to obtain samples of breast tissue, says Laura Singleton, billing specialist at the Center for Surgery & Breast Health in Joliet, Ill. "The surgeon uses imaging, such as ultrasound (76942), to locate the abnormal tissue to be biopsied. The device itself simply is inserted and then pulls out a core of tissue." Keep in mind that your surgeon may make several "passes" in order to ensure that he has obtained a sufficient sample for pathology, Singleton adds.

Code 19103 is also for a percutaneous procedure, but this code represents a procedure the surgeon performs using a "more sophisticated device that has suction or a rotating action to obtain the sample," Singleton explains.

In other words: "The difference between 19102 and 19103 is that 19102 is only the needle core biopsy using imaging," explains Karen Caputo, CCS-P, certified coder for the University of Toledo Physicians department of surgery/trauma services in Ohio. "19103 is using the stereotactic machine," she adds.

"Generally 19103 is the code to use for stereotactic biopsies because of the automated vacuum assisted or rotating device that is used," McCullough says.

For the "stereotactic" part of a stereotactic breast biopsy procedure, you might be able to report the radiological guidance if, in fact, your general surgeon performs that portion of the procedure.

"Surgeons do stereotactic breast biopsies themselves, or with assistance of radiology," says M. Tray Dunaway, MD, FACS, CSP, a surgeon, author, speaker, and coding educator with Healthcare Value Inc. in Camden, S.C. "Typically, we do it all when it's a stereotactic needle biopsy, and usually, we still get the radiologist to insert the search wire for an open procedure."

When the surgeon performs the stereotactic guidance, you should report 77031 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation). If your surgeon does not own the imaging equipment, append modifier 26 (Professional component).

"Our surgeons do these in short procedure units; therefore, we append the 26 modifier," says McCullough.

There are times, however, when your general surgeon will employ the help of a radiologist for a stereotactic breast biopsy. If the surgeon performs the biopsy with a radiologist in the room doing the localization, then as the surgeon's coder you would report 19103.

In this situation, the radiologist, not your surgeon, will bill for the stereotactic portion of the service. He will report 77031 for his part in the procedure.

If your surgeon uses another form of radiological imaging during a breast biopsy, CPT also allows you to report other imaging codes, such as 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), 77012 (Computed tomography guidance for needle placement-), 77021 (Magnetic resonance guidance for needle placement-), or 77032 (Mammographic guidance for needle placement, breast [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) in addition to 19102 or 19103, when appropriate, depending on the kind of imaging used in each particular case, Singleton says.

Example: If your surgeon performs a breast biopsy in the office using in-office ultrasound equipment, you should report 19102 or 19103 and the imaging code, 76942, for the procedure.

In a facility, if your surgeon dictates and signs the official report for the imaging service, you may be able to report the imaging separately using the appropriate CPT code with modifier 26 appended. Again, note that in most cases, however, a facility radiologist, rather than the surgeon, will report the imaging service.