Updates to Breast Biopsy and Arthrodesis Codes Top CPT 2001 Changes
Published on Fri Dec 01, 2000
The 2001 CPT manual, which becomes effective Jan. 1, 2001, includes several new codes and code revisions that affect general surgeons. Topping the list of changes is a reorganization of breast biopsy codes that includes three new codes and changes to several others all of which could significantly alter how these procedures are billed.
In addition, CPT 2001 includes an example that supports use of modifier -62 (two surgeons) by both surgeons during arthrodesis co-surgery, as well as a new section for abdominal aortic aneurysm.
Coinciding with the release of CPT 2001, the Health Care Financing Administration (HCFAs) final rule (which contains the 2001 fee schedule) was published in the Nov. 1, 2000, Federal Register. In addition to boosting the relative value unit (RVU) conversion rate from $36.6137 per RVU in 2000 to $38.2581 per RVU in 2001, to a 4.4 percent increase, the fee schedule also includes coverage and reimbursement information about the new CPT codes outlined below.
Breast Biopsy
CPT 2001 now offers a broader range of codes to cover all of the different ways surgeons can perform a breast biopsy. The changes mean that there now are codes for needle and incisional biopsies of masses the surgeon can palpate, and other codes for stereotactic and other biopsies that use imaging guidance, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C.
The following three new CPT 2001 breast biopsy codes relate to imaging guidance:
19102 biopsy of breast; percutaneous, needle core, using imaging guidance (6.66 RVUs);
19103 biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance (13.28 RVUs); and
19295 image guided placement, metallic localization clip, percutaneous, during breast biopsy (list separately in addition to code for primary procedure) (2.62 RVUs).
The addition of 19102 is important because it distinguishes between needle core biopsies with and without imaging guidance, says M. Trayser Dunaway, MD, FACS, a general surgeon in Camden, S.C. This is a good code, and it should pay a bit more (than the 19100), Dunaway says, noting that performing a biopsy with imaging guidance takes considerably more time than a basic needle core biopsy (19100).
Code 19103 describes the surgeons use of an automatic device to project the needle into the lesion or mass. Code 19295 should be used if the surgeon uses a new technique involving implanting a clip that monitors lesions over time. As an add-on (or list separately in addition to) code, 19295 should not be billed on its own, and most likely would be used appropriately with 19102.
In conjunction with the introduction of the new codes, the following existing breast biopsy codes have been revised:
19100 biopsy of breast; [...]
