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Pathology/Lab Coding Alert

Biopsy or Excision? Difference Explained in Coding Terms

Published on Wed Sep 28, 2005

Know the surgeons' language to decode breast tissue

Here's a surprise: Understanding surgical codes can help pathology coders distinguish pathology breast specimens.

The surgeon will perform a certain procedure - either a biopsy from 19100-19103 or an excision from 19120-19126. You need to know some terminology from these codes to make sense of your pathology reports and select the proper pathology code.

Learn Language of Biopsy Versus Excision

From a surgeon's standpoint, any tissue removed for pathology analysis may be a "biopsy." But from a coding standpoint, 19100-19103 describe removal of only a portion of a cyst, fibroadenoma, or other benign or malignant tissue for analysis, while excision as described by 19120-19126 involves removing the entire mass.

Remember: Keep that difference in mind when you look at the surgical codes. "No matter how the surgeon titles the operative report, biopsy is a piece, and excision is the whole thing," says Kim Garner, CPC, CCS-P, CHCC.

Look at the following surgical procedures to pick up some tips for decoding specimen descriptions:
 

  •  CPT 19100 - Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)
     
  •  19101 - ... open, incisional
     
  •  19102 - ... percutaneous, needle core, using imaging guidance
     
  •  19103 - ... percutaneous, automated vacuum-assisted or rotating biopsy device, using imaging guidance
     
  •  19120 - Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19140), open, male or female, one or more lesions
     
  •  19125 - Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion

  •  +19126 - ... each additional lesion separately identified by a preoperative radiological marker (list separately in addition to code for primary procedure).

    Lesson learned: What does this mean for pathology coders? You can be certain that you should use 88305 (Level IV - surgical pathology, gross and microscopic examination, breast, biopsy, not requiring microscopic evaluation of surgical margins) when you see certain terms like "needle core biopsy."

    Lesion-excision terminology should alert you that you might be able to use 88307 (Level V - surgical pathology, gross and microscopic examination, breast, excision of lesion, requiring microscopic evaluation of surgical margins) because the surgeon attempted to remove the entire lesion. "But you can't assume 88307 unless the pathology report documents margin evaluation," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.
     
    For a more complete discussion of breast coding, see "Zero In on Breast Specimens With Your New Best Coding Tool," on the cover of this issue.

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