Part B Insider (Multispecialty) Coding Alert

A breast localization device is a wire, needle, clip, or pellet that helps to mark the location of a small abnormality in the breast that cannot be detected by palpation during a physical examination. This procedure of localization ensures greater accuracy for biopsy of removal of a small lesion.

A breast localization device is placed under image guidance using a mammogram, MRI, ultrasound, or stereotactic guidance.

How is the procedure described?

When you read your oncologist’s documentation, it should not be difficult for you to confirm breast localization device utilization. For example, if your oncologist used wire guidance, you will read that your oncologist did a mammogram and then pierced a needle through the skin overlying the breast to have the tip of the needle near the lesion. Then your oncologist will thread a thin wire through the needle and withdraw the needle leaving the wire as a guide to the lesion. Finally, a repeat mammogram may be done to confirm the positioning of the wire before the wire is secured in place with a bandage. The wire will then be removed during the definitive procedure, during the biopsy or excision of the lesion.

Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc. lists the new CPT^® codes describing the localization, number of lesions treated and guidance used, below in this handy table to assist you in remembering how to apply the codes per the CPT^® long descriptions:

It is important to note: CPT codes +19282, +19284, +19286 and +19288 are add on codes and will only be reported in addition to the primary procedure code.