Wiki Axillary biopsy

This has been a long battle, and now I am going to ask you all. Patient presents to radiology for superficial axillary lymph node core needle biopsy. Dr. says it is a breast biopsy but everything clearly states superficial axillary lymph node core needle biopsy. All my coders say it is 38505. Dr. wants breast biopsy code. Thoughts?

kayroserey@cox.net said:

This has been a long battle, and now I am going to ask you all. Patient presents to radiology for superficial axillary lymph node core needle biopsy. Dr. says it is a breast biopsy but everything clearly states superficial axillary lymph node core needle biopsy. All my coders say it is 38505. Dr. wants breast biopsy code. Thoughts?

Click to expand...

I would not bill a breast biopsy if a breast biopsy wasn't documented.

What is the provider's reasoning for wanting to bill a breast biopsy? If it's just to get paid more, then they're asking you to commit fraud.

If they're saying that a breast biopsy was performed, then I'd put it back on them and ask why they didn't document a breast biopsy.

(Edit to add: Of course, I'm not looking at the documentation. The above is based on the fact that you and your coders are all in agreement that it was documented only as a superficial axillary lymph node biopsy.)

Coding guidelines for breast and axillary biopsies differ based on the type of procedure performed:

• Breast biopsy
  The Current Procedural Terminology (CPT) codes for breast biopsies are 19081–19086 and 19100. The code used depends on whether the procedure is performed with or without imaging guidance. For example, 19081 is used for stereotactic guidance, 19083 is used for ultrasound, and 19085 is used for MRI. If a second lesion is biopsied using the same imaging, an add-on code is used. If a localization device is placed without performing a biopsy, codes 19281–19288 are used.
  
  
  
• Axillary biopsy
  The CPT codes for axillary biopsies include 38500, 38525, and 38792:
  
  
  • 38500: Used for the biopsy of superficial axillary lymph nodes (SLNs)
    
    
    
  • 38525: Used for the biopsy of open, deep axillary lymph nodes
    
    
    
  • 38792: Used for the injection procedure if performed
    
    

Other codes that may be used for axillary biopsies include:

• 38900: Used to report the work associated with intraoperative identification of the sentinel node
  
  
  
• 19162, 19200, 19220, 19240: Used for combined breast and axillary procedures

I work for a comprehensive Breast Center. One of our surgeons does these all the time. The correct coding for the axillary lymph node would be 38505, 10035. Because when they do the 38505, they will also insert a soft tissue marker as well. Where as the 19083- (Breast) as the tissue marker built into the charge. I hope that this is helpful.