Ob-Gyn Coding Alert

If there's more than 1 biopsy, look to -50, -51 and -59 If you're constantly battling payers over the reduction of reimbursements and denials of second procedures along with breast lesion excisions or breast biopsies, this expert coding advice is for you.
 
In most cases, if an ob-gyn performs a breast biopsy, he will only extract a small portion of the lesion. For this reason, you're not likely to report additional codes for wound closure or skin grafts, but you might report more than one biopsy per breast or multiple biopsies in both breasts, says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert in Fredericksburg, Va.
 
You may also find that you report adjunct procedures such as 1) placement of a clip to identify the site if the biopsy should come back as malignant or 2) radiologic imaging procedures.
 
What to Expect: You'll receive full reimbursement for the first biopsy, but payers will discount the amounts for any additional surgical procedures. Payers reimburse only for the intraoperative portion for additional biopsies and procedures. You can expect full payment for at least the professional component for a radiologic imaging procedure. Also, if the payer uses Medicare guidelines, you won't be reimbursed separately for any anesthesia service including conscious sedation - that includes supplies as well. Ask 2 Questions for Needle Biopsies When an ob-gyn performs a biopsy through the skin using a needle, scalpel or rotating biopsy device, you'll have six code choices to choose from:
10021 - Fine needle aspiration; without imaging guidance
10022 - ... with imaging guidance
19100 - Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)
19101 - ... open incisional
19102 - ... percutaneous, needle core, using imaging guidance
19103 - ... percutaneous, automated vacuum-assisted or rotating biopsy device, using imaging guidance. If the ob-gyn performs the biopsy using a needle, you should ask yourself two questions: First, did he incise the skin prior to inserting the needle into the lesion? Second, was the specimen collected using imaging guidance? The answers will help you pick appropriately  between a fine needle and needle core biopsy. An open incisional biopsy would not involve use of a needle to collect the specimen.
 
Know your terms: "Percutaneous" means that a small skin incision has been made to ease the insertion of the needle into the lesion; using sutures to close the incision would be included as part of the procedure, Witt says.
 
Note: If the ob-gyn performs the biopsy using an automated vacuum or rotating biopsy device, then there should always be imaging documentation. How to Report More Than 1 Biopsy If the ob-gyn performs more than one biopsy, you would reflect this by using modifier [...]