Oncology & Hematology Coding Alert

Question: If our doctor performs a partial mastectomy and uses a Savi Scout reflector for guidance to the tumor site, is it bundled into the main procedure, or can we report this separately from the surgery? If so, what would be the best code to use for the Savi Scout?

AAPC Forum Participant

Answer: A parenthetical note underneath partial mastectomy codes 19301 (Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)) and 19302 (… with axillary lymphadenectomy) tells you “Intraoperative placement of clip[s] is not separately reported.”

Similarly, several reference articles in CPT^® Assistant (Vol. 24, Issue 6 and Vol. 25, Issue 6) and AHA HCPCS Coding Clinic (Vol. 14, No. 2) for breast localization device codes (19281- 19288) tell you that percutaneous breast localization devices such as clips, metallic pellets, wires/needles, and/or radioactive seeds that are “placed intraoperatively (i.e., during the skin-to-skin portion of a mastectomy procedure)” are “not … separately reportable” per CPT^® Assistant (Vol. 31, Issue 5).

From this, you can easily conclude that a localization device such as the Savi Scout, which reflects radar signals to pinpoint the tumor site precisely, cannot be separately reported. However, the same issue of CPT^® Assistant notes that if a device is placed in a procedure separate from the mastectomy, usually prior to performing to the 19301/19302 procedure, the device placement is separately reportable.

The CPT^® Assistant article uses two scenarios to illustrate this:

Scenario 1: Prior to the partial mastectomy procedure, a radiologist uses mammographic imaging to place a location device. If this is the only service the radiologist performs, the radiologist would report 19281 (Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance).

Scenario 2: Prior to performing the partial mastectomy procedure, the surgeon uses ultrasound to place a localization device, then performs the partial mastectomy. In this case, the surgeon would report 19285 (Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance) along with the appropriate code from 19301/19302. In order to show that the partial mastectomy is a separate procedure, you will also append modifier 59 (Distinct procedural service) or XE (Separate encounter) to the 19285, depending on payer preference.

“In summary, the intent of the parenthetical note … following the mastectomy codes was to disallow and prevent separate reporting of placing a device in the open mastectomy wound or cavity, for example, to mark the margins of the excision for future operations or services (e.g., radiation therapy). This was to acknowledge the minimal work required to place a clip or wire in an open wound. The qualifying factor for reporting image-guided percutaneous localization device placement is that the device is not placed intraoperatively (ie, during the skin-to-skin portion of a mastectomy procedure), which would not be separately reportable,” the CPT^® Assistant article concludes.