General Surgery Coding Alert

Question: Ive received several answers on how to code the mammotomy and stereotactic breast biopsy. Can you clarify this?

Anonymous GA Coder

Answer: Breast biopsy is generally performed by one of the following methodsfine needle aspiration, needle core, incisional or excisional biopsy. The use of a mammotome or ABBI device is considered by most insurers, including HCFA, to represent the work included in an incisional biopsy, but some payers require documentation supporting the existence of a non-palpable lesion, says Cindy Parman, CPC, of Coding Strategies, a physician reimbursement consulting firm in Dallas, GA. This sampling technique uses one puncture site to gather several tissue specimens, providing a more complete assessment of the patients breast pathology.

The codes for this service may include 19101 (mammotome biopsy [including all tissue specimens obtained]); 76095 (stereotactic imaging [including all films taken]); and 76098 (specimen radiograph, when performed).

Note: The general surgeon can only bill 76095 and 76098 provided he or she actually performed and interpreted the procedures without the assistance of a radiologist. Dont forget to add modifier -26 (professional component) to the radiologic services if the general surgeon does not own the radiology equipment.

There is no separate charge for any scout mammography films obtained prior to the stereotactic imaging, Parman says. The CPT code for the imaging service (76095) is billed once per lesion biopsied. The procedure code (19101) is also coded and billed once per lesion, regardless of the number of specimens obtained.

For example, if one lesion is biopsied and 12 separate samples are obtained, the service is coded and billed once. The specimen radiograph is coded and billed when the tissue removed for biopsy is separately imaged.