Radiology Coding Alert

Question: Our radiologist took samples from two different areas of a lesion during a stereotactic breast biopsy. May we code and bill this service twice?

Hawaii Subscriber

Answer: No, 76095 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) should be reported per lesion. Furthermore, the surgical codes for biopsy are also billed once per lesion (e.g., 19103, Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance).

If more than one lesion in the breast is sampled, coders should record the correct number of biopsies in the units field of the claim form or use separate lines on the same claim form with a unit of one. Nonetheless, when samples are taken from multiple lesions, some coding experts recommend appending modifier -51 (Multiple procedures) or -59 (Distinct procedural service) to the code. This tells the payer that the lesions localized were at different sites on the breast so the service is not denied as a duplicate submission. Lesions biopsied in the contralateral breast would be indicated by modifier -50 (Bilateral procedure) associated with the second code(s). This increases the chance that the practice will be reimbursed for the extra work and physician effort without resorting to repeat submissions after an initial denial.