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Ob-Gyn Coding Alert

Use Breast Biopsy Guidelines to Fight Denials

Published on Sun Jan 02, 2005

Put 19160, 19162 for partial mastectomies into practice

Before you start coding breast procedures, you should take a look at the new 2005 guidelines for excisional breast procedures (19100-19272). The new guidelines clarify the correct codes to use depending on the approach and the amount of tissue the ob-gyn removes. Here are the highlights:
 

  • Report breast biopsies using 19100 (Biopsy of breast; percutaneous, needle core, not using imaging guidance [separate procedure]), 19101 (... open, incisional), 19102 (... percutaneous, needle core, using imaging guidance), or 19103 (... percutaneous, automated vacuum-assisted or rotating biopsy device, using imaging guidance). 
     
  • Report open excision of breast lesions (such as lesions of the breast ducts, cysts, benign or malignant tumors), without specific attention to adequate surgical margins, with or without the preoperative placement of radiological markers using 19110-19126. 
     
  • Partial mastectomy procedures such as lumpectomy, tylectomy, quadrantectomy, or segmentectomy are open excisions of breast tissue with specific attention to adequate surgical margins. Report these procedures using 19160 (Mastectomy, partial) or 19162 (... with axillary lymphadenectomy). 
     
  • Total mastectomy procedures include simple mastectomy, complete mastectomy, subcutaneous mastectomy, modified radical mastectomy, radical mastectomy, and more extended procedures like the Urban type operation. Report these procedures with 19180 (Mastectomy, simple, complete), 19182 (Mastectomy, subcutaneous), 19200 (Mastectomy, radical, including pectoral muscles, axillary lymph nodes), 19220 (Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes [Urban type operation]), or 19240 (Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle). 
     
  • Report excisions or resections of chest wall tumors including ribs, with or without reconstruction, with or
    without mediastinal lymphadenectomy using 19260 (Excision of chest wall tumor including ribs), 19271 (Excision of chest wall tumor involving ribs, with plastic reconstruction; without mediastinal lymphadenectomy), or 19272 (... with mediastinal lymphadenectomy). The guidelines also clarify that you can use 19260-19272 to report resections of chest wall tumors originating from any part of the chest wall, not just the breast.
      
    Take action: Now that you have read through these clarifications, you should begin implementing them now into your daily coding practice.
     
    "Read through the new guidelines, review your policy and procedure, and make the necessary revisions. If you do not have a policy and procedure, create and implement one," says Amy McCreight, CPC, a compliance research analyst at Ohio Health in Columbus. "Make sure to educate and distribute the policy to the staff."

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