Radiology Coding Alert

Question: Can we separately bill a guided breast biopsy, 19102, and a diagnostic mammogram if the radiologist performs both services? What if a clip is placed?

Connecticut Subscriber

Answer: In coding lingo, you are wondering if you can be separately reimbursed for a breast biopsy, 19102, a clip placement with guidance, +19295 (Image guided placement, metallic localization clip, percutaneous, during breast biopsy [list separately in addition to code for primary procedure]), and a follow-up mammogram, 76090 (Mammography; unilateral), or if they are bundled procedures.

The answer depends on what type of imaging guidance was used to perform the breast biopsy. The only type of guidance that would allow you to bill the three procedures separately is ultrasonic, CPT code 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). In other words, if the visualization was performed under ultrasonic guidance, report codes 19102 (Biopsy of breast; percutaneous, needle core, using imaging guidance), 76942, 19295 and 76090. You may need to append modifier -26 (Professional component) to 76942 depending on whether the radiologist owns the imaging equipment.

On the other hand, if you are wondering if you can code separately for a follow-up mammogram after the radiologist performed a breast biopsy and a clip placement performed with either stereotactic or mammographic guidance, then the answer is no.

The code for the mammogram, 76090, is bundled into stereotactic and mammographic guidance codes 76095 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) and 76096 (Mammographic guidance for needle placement, breast [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation). So you should only report codes 19102, 19295 and either 76095 or 76096.

Be aware that not all payers, not even all Medicare carriers, will necessarily reimburse for both the biopsy under ultrasonic guidance with clip placement and the unilateral diagnostic mammogram. Consult with your individual insurer before billing both services.