Radiology Coding Alert

Question: Our office has been debating when to report CPT 76098 . Should we use it for x-rays taken of the breast after the physician removes a lesion?


Maine Subscriber

Answer: Actually, report 76098 (Radiological examination, surgical specimen) when the radiologist examines a tissue specimen removed during surgery, regardless of where the specimen came from on the body.

You often use 76098 when a surgeon removes tissue from the breast after the radiologist localizes the lesion with a wire. The radiologist uses x-ray technology to examine the specimen, looking for evidence that the physician removed everything he needed to. The radiologist can then confirm that the physician excised the appropriate area.

Example: Your radiologist performs a biopsy using a rotating needle, vacuum-assisted device (such as ABBI or Mammotome) and then x-rays the specimen to ensure that the sample contains the questionable tissue (such as microcalcifications).

In the rare case that a radiologist orders additional breast x-rays after removing a lesion, report a unilateral mammogram (76090, Mammography; unilateral) and document the medical necessity for post-biopsy films. Watch out: Only report this code for patients of payers that specifically allow separate reporting of post-biopsy imaging studies in addition to the RS&I for the biopsy itself. Most payers include any images obtained during the biopsy and after the biopsy to be included in the RS&I of the biopsy. The same is true for placement of localization devices - except for the specific code that describes the placement of a localization device after a biopsy has been performed and in conjunction with the biopsy.

Planning: Most payers bundle these post-biopsy mammographic images into services performed the same day, such as 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). Both of these codes include the procedure and physician interpretation of the results, including any number of films, to ensure that the procedure is complete.