Radiology Coding Alert

Medicare's national coverage determination (NCD) for "Percutaneous Image-Guided Breast Biopsy (220.13)" states, "Medicare covers percutaneous image-guided breast biopsy using stereotactic or ultrasound imaging for a radiographic abnormality that is nonpalpable and is graded as a BIRADS III [probably benign], IV [suspicious abnormality], or V [highly suggestive of malignant neoplasm]."

The NCD also states that "Medicare covers percutaneous image guided breast biopsy using stereotactic or ultrasound imaging for palpable lesions that are difficult to biopsy using palpation alone. Contractors have the discretion to decide what types of palpable lesions are difficult to biopsy using palpation."

Don't overlook: Payers may add additional helpful guidelines, such as "When multiple lesions are involved; billing is dependent on the location of the lesion and the number of lesions. Documentation in the patient's progress notes must indicate that the separate lesions are independent of each other, and that each biopsy is medically necessary." You can find this in the WPSIC document "Percutaneous Image-Guided Breast Biopsy" (RAD-028) available at www.wpsic.com/medicare/part_b/policy/rad028.pdf.