Radiology Coding Alert

Question: Our radiologist performed a bilateral percutaneous breast biopsy with placement of a clip. Three biopsies of the left breast were taken and one biopsy of the right breast. We are receiving denials when submitting 19083-LT, 19083-RT, and +19084-LT. What are we doing wrong?

Louisiana Subscriber

Answer: The answer to this question involves a thorough analysis of the CPT^® guidelines found in the Surgery/Integumentary System/Breast section of the CPT^® book. Specifically, on page 105, you’ll come across the following instructions:

“To report bilateral image-guided breast biopsies, report 19081, 19083, 19085 for the initial biopsy. The contralateral and each additional breast-image guided biopsy are then reported with +19082, 19083, +19086.”

In other words, you should not be assigning bilateral or unilateral modifiers to 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) or +19084 (…each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)). Instead, CPT^® instructs that you report code +19084 for same-sided breast biopsies with multiple lesions and when the same service is performed on one or more lesion of a contralateral breast.

This means that you should revise the coding so that 19083 accounts for the first lesion of the left breast, and three units of +19084 account for the remaining two lesions of the left breast and the single lesion of the right breast. The coding should go as follows:

• 19083
• +19084 x 3.