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Wiki Breast lesion localization

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HOLLYGIFFIN

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Denton, TX
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NEED HELP!!! We have a center (outpatient hospital) that performed ultrasound guided lesion localization (76942 and 19290) The center is providing the equipment but a surgeon is coming into the operating suite and placing the wire. Does the hospital code both the 76942 and 19290 and get paid under the OPPS package payment? I don't know if we are to charge the 19290.
 
HOLLYGIFFIN said:
NEED HELP!!! We have a center (outpatient hospital) that performed ultrasound guided lesion localization (76942 and 19290) The center is providing the equipment but a surgeon is coming into the operating suite and placing the wire. Does the hospital code both the 76942 and 19290 and get paid under the OPPS package payment? I don't know if we are to charge the 19290.
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Yes, the hospital will code both 19290 and 76942 (the physician will code 19290 and 76942-26). Under OPPS, you will get paid for 19290 but 76942 is packaged.
(Assuming that this is a breast lesion, for non-breast wire localization, use unlisted surgical code for the body area. And assuming that they proceded to biopsy, you will also code both surgical and guidance codes for that.)
 
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