Radiology Coding Alert

Question: A separate provider performed a percutaneous breast biopsy of two lesions under ultrasound (US) guidance. Prior to the biopsy, our radiologist performed the placement of breast clips on each lesion under US guidance. Our radiologist also performed the X-ray of the surgical specimen. How should I code for our radiologist’s services?

Mississippi Subscriber

Answer: When a provider performs the placement of a breast localization device under US guidance without a subsequent biopsy, you may report code 19285 (Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance) and +19286 (…each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)) for each additional lesion. Furthermore, a separate provider performing a surgical specimen X-ray on one or more days following a breast biopsy should not report 76098 (Radiological examination, surgical specimen). Clinical Examples in Radiology (Spring, 2014) states that an interpreting radiologist may not report code 76098 despite not having been involved in the biopsy portion of the procedure.

The same concept applies to the billing for the placement of a clip from a separate provider than the one performing the biopsy. The provider performing the biopsy will be reporting codes 19083 (Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance) and +19084 (…each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)). As you can see in the code descriptions, the placement of the clip and the surgical specimen X-ray are already included in the work performed by the provider performing the biopsy. Whether your radiologist performs the placement of the clip on a prior day or the same day, you should not bill separately for those services when they are included in the underlying biopsy procedure.

Caveat: If the provider performs the placement of a breast clip or other needle localization device prior to an open surgical biopsy of the breast, you may bill for their services. The same applies to instances where the same provider performs the open biopsy and the placement of the breast localization device.

In this example, in order to be reimbursed for the placement of the clip and the radiological examination of the surgical specimen, your provider would need to arrange into a contractual agreement with the physician performing the biopsy so that each party receives their respective portion of the reimbursement included in codes 19083 and +19084. Coming to a financial arrangement is especially important for logistical reasons if the providers plan to continue performing biopsy procedures in tandem in the future.