Reader Question:
2 Breast Lesions? Use 2 Codes
Published on Tue May 11, 2004
Question: We recently performed stereotactic local-ization and biopsy on two right breast lesions. Can we report 76095 more than once? Should we use a modifier?
Virginia Subscriber Answer: Because CPT's definition of 76095 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) includes the phrase "each lesion," you can bill two units.
Some consultants recommend that you append modifier -59 (Distinct procedural service) to second and subsequent line items. Modifier -59 may eliminate the possibility that your payer will deny the subsequent line items as duplicate submissions.
Some insurers recommend that you append modifier -51 (Multiple procedures) to the second line to alert the payer that the second line item is not a duplicate charge.
Remember: If you take more than one specimen from the same lesion, you can report only one unit of 76095.
