Case Study:
Eliminating Confusion When Coding Breast Biopsy Procedures
Published on Wed Dec 01, 1999
In order to lessen coding confusion, code 19101 was recently introduced so breast imaging practices could receive reimbursement that accurately reflects the increased physician time and associated costs of emerging technologies. But coders must understand the circumstances that distinguish two of the most common codes: 19100 (biopsy of breast; needle core [separate procedure]) and 19101 (biopsy of breast; incisional [separate procedure]).
Historically, CPT Code 19100 had been assigned to the procedural component of virtually all breast biopsies. However, the relatively recent emergence of stereotactic instruments has made it possible to biopsy small, nonpalpable lesions for definitive diagnosis. The advent of this new technique necessitated a corresponding procedural code19101.
The Health Care Financing Administration (HCFA) advised Medicare carriers that surgical code 19101 had been added to reflect the new biopsy techniques made possible by stereotactic technology. It noted that 19101 should be used to report image-guided incisional biopsies of nonpalpable breast lesions. Organizations such as the American College of Radiology (ACR) lobbied heavily for this new code because it more accurately reflects the additional physician time and higher costs (i.e. supplies, technology) related to stereotactic breast core biopsies of this nature.
The use of 19101 is not restricted in any way by the type of surgical devise used (i.e. core needle, mammotome), according to the ACR.
In addition, it reports that needle core biopsies of palpable lesions using needles such as Tri-cut should continue to be reported with CPT code 19100.
Three Areas of Confusion
Following is an example of a core needle biopsy, performed with stereotactic guidance. It has correctly been assigned CPT code 19100 (accompanied by radiologic supervision and interpretation [RS&I] code 76095) because the procedure is not incisional.
HISTORY: Clustered microcalcifications in the left breast
BREAST CORE BX
FINDINGS: After obtaining informed consent and explaining to the patient the whole procedure, a left breast stereotactic core biopsy was performed using a 14-gauge needle for the biopsy. The patient tolerated the procedure without any difficulty. Post-biopsy instructions were given to the patient.
IMPRESSION: Left breast stereotactic core needle biopsy for calcifications. A separate report from the pathology department shows focal presence of highly atypical intraductal lesion associated with microcalcifications regraded as intraductal carcinoma with high nuclear grade. No invasion. Deeper sections will be obtained and an addendum from the pathology department will be issued.
ICD-9 793.8
BI-RADS: (4) Suspicious abnormalitybiopsy should be considered
CPT: 19100/76095
1. A significant area of confusion surrounding these two codes [...]
