Oncology & Hematology Coding Alert

Keep your focus on the type of image guidance used.

Your coding for breast procedures will get more specific in 2014. To report the right codes, you’ll need to count the number of lesions and confirm what type of image guidance the oncologist used.

Confirm Image Guidance for Localization Devices

There are several types of imaging guidance your oncologist may use when placing a localization device. Your first step is to confirm what type of guidance was used and then to look at the new 2014 CPT® code set to assign a code for the first, then each additional lesion. Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc, shares a general explanation of each of these guidance techniques:

Mammographic guidance: using radiation/X-ray image of breast tissue to verify the placement of the localization device near the targeted tissue.

• Stereotactic guidance: a special mammography machine using x-rays to help guide the provider’s instruments to the site of the abnormal growth.
• Ultrasound guidance: high frequency sound waves (ultrasound) are sent and received by a machine, creating image used to guide needle placement.
• Magnetic resonance guidance: use of powerful magnetic fields and radiofrequency pulses to create detailed images.

For an overview of the new CPT® codes describing the localization, number of lesions treated and guidance used, see the table below, provided by Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc :

Keep in mind: CPT® codes +19282, +19284, +19286 and +19288 are add-on codes and will only be reported in addition to the primary procedure code.

Check to Ensure Documentation Supports Breast Biopsy

“2014 will offer you three new codes for breast biopsy using localization devices,” says Loya. These codes are structured much like the placement of the localization device codes in the chart. They too require the use of a primary CPT® and add-on code for each additional lesion. The new codes are as follows:

Important: Codes 19081, 19083, and 19085 are for percutaneous biopsy of the first lesion in the breast. For each additional lesion biopsied, you report codes +19082 (……..each additional lesion, including stereotactic guidance [List separately in addition to code for primary procedure]), +19084 (……each additional lesion, including ultrasound guidance [List separately in addition to code for primary procedure]), +19086 (…………each additional lesion, including magnetic resonance guidance [List separately in addition to code for primary procedure]) for stereotactic, ultrasound, or MRI guidance, respectively.

Remember: CPT® codes +19082, +19084 and +19086 are add-on codes and will only be reported in addition to the primary procedure code.

Nix These Biopsy Codes in 2014

The placement and biopsy codes will be more specific to the number of lesions and imaging used. CPT® will delete the following breast biopsy codes effective January 1, 2014:

• 19102 (Biopsy of breast; percutaneous, needle core, using imaging guidance)
• 19103 (Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance)
• 19290 (Preoperative placement of needle localization wire, breast)
• +19291 (Preoperative placement of needle localization wire, breast; each additional lesion [List separately in addition to code for primary procedure])
• +19295 (Image guided placement, metallic localization clip, percutaneous, during breast biopsy/aspiration [List separately in addition to code for primary procedure])

Editor’s note: Look for more updates on 2014 codes in future issues of Oncology Coding Alert.