Coding Percutaneous Breast Biopsies

Teri Romano, RN, MBA, CPC

The American Medical Association’s Current Procedural Terminology (CPT) was updated in 2014 to reduce the amount of codes required for percutaneous breast biopsies. Prior to the changes, a percutaneous breast biopsy was reported with up to three codes: the biopsy itself, the imaging used to guide the biopsy, and the placement of a localization device, when used. The procedures may now be reported as one code. Similarly, when placement of the localization device is performed without a biopsy at the same session, it may now also be reported as a single code, reduced from its previous two code requirement reflecting the device placement and the image guidance.

As shown in Table 1, the revised percutaneous breast biopsy codes are reported by lesion or mass. The first lesion is reported with a primary code: 19081, 19083, or 19085. The selection of the primary code is based on the imaging used to guide the biopsy. A biopsy with stereotactic guidance is reported as 19081, ultrasound with 19083, and MRI with 19085. If a second lesion is biopsied using the same imaging, an add-on code is reported: 19082, 19084 or 19086. If a second lesion is biopsied using a different imaging modality a second primary code is reported specific to the image guidance used.

These codes also include placement of a localization device, “when performed.” This includes placement of a clip or marker, pellet, or other localization device. The wording “when performed” indicates that these codes may be used for a percutaneous biopsy with imaging without placement of a localization device.

The scenarios below demonstrate appropriate coding for percutaneous breast biopsies using image guidance.

Scenario #1

A percutaneous biopsy is performed on a single breast mass with placement of a clip using ultrasound guidance.

Code(s) 19083
Scenario #2

A percutaneous breast biopsy is performed of a right outer quadrant mass in the left breast with stereotactic guidance and of a second lesion in the left lower quadrant of the left breast with ultrasound guidance.

Code(s) 19081 and 19083

Table 2 summarizes the revised codes for percutaneous placement of a localization device. These codes reflect only the work of placing a localization device under image guidance. These codes are never reported in combination with the percutaneous biopsy codes above, since those codes include the work of placing a localization device.  

The codes for placement of a localization device are specific to the type of imaging used.  For example, placement of a device in a single lesion using mammography is reported with the primary code of 19281.  If devices are placed in additional lesions also using mammography, the add-on code of 19282 is reported.  Primary codes for other imaging modalities include 19283 for stereotactic, 19285 for ultrasound and 19287 for MRI. As with biopsy codes, an add-on code (19282, 19284, 19286 and 19288) is used for devices placed in an additional lesion using the same imaging modality. If localization devices are placed in two separate lesions using two separate imaging modalities, two primary codes are reported.  

The scenarios below demonstrate appropriate coding for percutaneous placement of localization devices with imagine guidance.

Scenario #1

A localization device is placed under ultrasound guidance in a single breast mass.

Code(s) 19825

Scenario #2
Localization devices are placed percutaneously in two breast lesions both under stereotactic guidance.

Code(s) 19283 and +19284

These new codes are reported for image guided percutaneous biopsy and image guided placement of a localization device. If a percutaneous biopsy is performed without image guidance, code 19100, Biopsy of breast, percutaneous, needle core, not using imaging guidance, is the correct code choice.

Teri Romano is a consultant with KarenZupko & Associates, Inc., a practice management firm working nationally with surgical practices. Access www.karenzupko.com.

Table 1

Percutaneous Biopsy, Imaging, and Localization Devices: Combined Codes
CPT Code Description	Guidance	First Lesion	Each Additional Lesion [Listed separately in addition to code for primary procedure]
Biopsy, breast with placement of breast localization device [s] [e.g., clip, metallic, pellet], when performed and imaging of the biopsy specimen, when performed percutaneous	Stereotactic	19081	+19082
	Ultrasound	19083	+19084
	Magnetic  resonance	19085	+19086

Table 2

Placement of Localization Device with Imaging
CPT Code Description	Guidance	First Lesion	Each Additional Lesion [Listed separately in addition to code for primary procedure]
Placement of breast localization device [s] [e.g., clip, metallic, pellet, wire/needle radioactive seeds], percutaneous	Mammographic	19281	+19282
	Stereotactic	19283	+19284
	Ultrasound	19285	+19286
	Magnetic resonance	19287	+19288