General Surgery Coding Alert

Nugget: If the operative report isn't clear, coders should ask their physicians what procedure was performed before billing for breast biopsies to secure proper payment.
There are several procedures that fall under the category of breast biopsy, and even more codes to describe them; so general surgeons need to be specific about the procedure performed in their operative reports. Similarly, coders need to familiarize themselves with the different types of breast biopsies and then carefully read the operative report to determine how best to code what their surgeon did.
 
Given the proliferation of breast biopsy codes, the most important thing a coder needs to do before billing out such procedures is to determine exactly what procedures were performed, says Cynthia Swanson, RN, CPC, a coding and reimbursement specialist with Seim, Johnson, Sestak & Quist, an accounting firm in Omaha, Neb. The physician may not be descriptive enough in their narrative, however, so coders need to impress upon their doctors the importance of improving their descriptions of these procedures, maintains Swanson. That, of course, doesn't solve the immediate problem of figuring out just which procedures actually were performed. "If you can't understand what the op note says, you have to go the physician and ask him or her to tell you," Swanson says. Mostbut not allbreast biopsy procedure codes are located in the 19000-section of the CPT manual. The differences among these procedures depend on the kind of tissue being excised and the method used to access it. At a glance, some of these procedures resemble each other. For example, coders without a clinical background easily may confuse codes 19000 (puncture aspiration of cyst of breast), 19100 (biopsy of breast, needle core [separate procedure]), 19101 (biopsy of breast, incisional), and 19120 (excision of cyst, fibroadenoma or other benign or malignant tumor aberrant breast tissue, duct lesion, nipple or areolar lesion [except 19140], male or female, one or more lesions).
 
The confusion is compounded once other techniques, such as fine needle aspiration (88170, fine needle aspiration with or without preparation of smears; superficial tissue [e.g., thyroid, breast, prostate]) and stereotactic breast biopsies are considered. In short, the problem for coders is how to distinguish among the various procedures.
Palpable Lesions
When a patient presents with a breast lump that can be palpated (i.e., felt by the surgeon through the skin), the surgeon likely will try to determine if it contains mostly fluids or solids. If the lump is a cyst, the surgeon will try to suck out the fluid with a syringe. This procedure is coded 19000. If there are additional cysts, code 19001 (each additional cyst [list separately in addition to code for primary procedure]) is used for each additional one. After [...]