Oncology & Hematology Coding Alert

Question: Which CPT® codes can we report for needle-core and rotating biopsy device for breast biopsy?

Tennessee Subscriber

Answer: CPT® no longer distinguishes breast biopsy codes based on sampling method. You will no longer look at the sampling method your physician used. Instead, you should base your breast biopsy code selection on imaging modality. For an initial breast lesion biopsy, select one of the following codes:

• 19081 — Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet),when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance
• 19083 — ... first lesion, including ultrasound guidance
• 19085 — ... first lesion, including magnetic resonance guidance.

Change codes for additional lesions: If your surgeon takes more than one biopsy in a single session, you need to turn to different codes for the second and subsequent biopsy. For each additional lesion biopsied, you should report one of the following 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).

Remember: CPT® codes +19082, +19084, and +19086 are add-on codes. You can report them only in addition to the primary procedure code.

Old way: You asked about distinguishing breast biopsy based on sampling modality. That’s how you selected the codes prior to 2014, when CPT® deleted the two breast biopsy codes 19102 and 19103. This provides a good example of why practices must keep abreast of procedure code changes, to accurately report — and get paid for — services that your physician provides.