Radiology Coding Alert

The December 1999 Radiology Coding Alert contained a case study on page 34 Case Study: Eliminating Confusion When Coding Breast Biopsy Procedures. This article indicated that CPT Code 19100 (biopsy of breast; needle core [separate procedure]) should be used for a core needle biopsy of clustered microcalcifications. Readers have contacted us noting that the American College of Radiology and other coding experts recommend that instances like this be coded with 19101 (biopsy of breast, incisional) since the example was a nonpalpable lesion biopsied under imaging guidance.

According to Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C., 19101 would indeed be the correct code to assign in this instance. This has been an issue that has caused much confusion, she says. Typically, 19100 would be the code assigned for needle core biopsies of breast lesions. Likewise, 19101 is to be used only for incisional biopsies. However, the Health Care Financing Administration (HCFA) has added a new dimension to the coding of breast biopsies by allowing code 19101 to be billed for imaging guided biopsies of nonpalpable lesions of the breast. Stereotactic biopsies, by their very nature, employ guidance.

The coding guideline that allows 19101 for stereotactic needle core biopsies is based on the fact that the level of work involved in the stereotactic interventional procedure is greater than that for standard needle core biopsies.

Coders must note that commercial carriers may or may not agree with this policy and still may require 19100 to be assigned for all needle core biopsieswhether the lesion is palpable and whether guidance is used. For this reason, you should check with your commercial carriers in advance to determine their policy.

In addition, your documentation should clearly demonstrate that the lesion was not palpable and that guidance was used, if you are billing Medicare or another payer that accepts HCFAs definition.