Radiology Coding Alert

Question: When our radiologist performs stereotactic localization and biopsy of more than two breast lesions on the right breast, can our practice bill 76095 more than once? If so, what modifier, if any, should we add?

Idaho Subscriber

Answer: Code 76095 is described in CPT as stereotactic localization for breast biopsy, each lesion, radiological supervision and interpretation. Because the wording in the manual clearly refers to each lesion, billing for more than one unit is appropriate. You may bill for each lesion that is localized and biopsied by indicating the precise number of lesions in the unit field of the HCFA-1500 form.

Many expert coders recommend that you append modifier -59 (distinct procedural service) to 76095 for localization for the second and subsequent lesions to get reimbursed for the service, although billing for each lesion is standard procedure. This makes it clear to the payer that the lesions localized were at different sites on the breast so they dont deny the service as a duplicate submission.

Coders should note that they can assign 76095 only once, however, if more than one specimen is taken from the same lesion.