Radiology Coding Alert

Question: If the radiologist performs a breast biopsy (19103) with clip placement and uses a digital mammogram (G0206) to check clip placement, may I report both codes?

Washington Subscriber

Answer: Take a careful look at the imaging modality the radiologist used for biopsy guidance and clip placement before you code.

Some payers may offer separate payment for a diagnostic mammogram (G0206, Diagnostic mammography; unilateral) with clip placement confirmation code +19295 (Image-guided placement, metallic localization clip, percutaneous, during breast biopsy). Key: The radiologist must have used and documented performing the biopsy under ultrasound or MRI guidance.

The radiologist's documentation should include why he used either ultrasound or MRI to guide the intervention and then used mammography to document the clip's location.

And if you do report a diagnostic mammogram in this situation, MQSA requirements may apply (such as communicating results to the patient).

Watch out: Stereotactic or mammographic guidance use is another story. If the radiologist performs the breast biopsy using these, payers include the follow-up mammogram in the guidance codes:

• 77031 -- Stereotactic localization guidance for breast biopsy or needle placement (e.g., for wire localization or for injection), each lesion, radiological supervision and interpretation

• 77032 -- Mammographic guidance for needle placement, breast (e.g., for wire localization or for injection), each lesion, radiological supervision and interpretation.

Safe bet: Check with your payer to be sure.