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. Choose a Biopsy Code First 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. You-ll Sometimes Leave 77031 for the Radiologist 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 [...]