General Surgery Coding Alert

Question: Our surgeon performed percutaneous placement of metallic pellets using stereotactic guidance in a right upper outer quadrant breast lesion and a right axillary lymph node lesion. How should we report the service?

Tennessee Subscriber

Answer: Optimum coding for these procedures would be 19283 (Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance) and 10035 (Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion).

Because you describe placement of two separate lesion markers, so you should code separately for each placement. CPT^® provides several codes for surgically marking lesions prior to therapy using devices such as clips, metallic pellets, or wires. Many of the codes are site or tissue specific, such as the following: 

• For breast localization using different guidance methods: 19281-+19288 (Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous …)
• For intra-thoracic markers: 32553 (Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple)
• For abdominal markers: 49411 (Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple)
• For prostate markers: 55876 (Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple)
• For soft tissue markers: 10035, +10036 (Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; …)

Caution: Correct Coding Initiative (CCI) edits bundle 19283 as a column 2 code with 10035, so you’ll need to append an appropriate modifier, such as 59 (Distinct procedural service) to 19283 when you bill these codes together.