Ambulatory Coding & Payment Report
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You Be the Coder: How Do You Claim Multiple Breast Biopsies?

Question: How can I bill for multiple breast biopsies? This is for sampling breast tissue itself, not skin on the breast.

Answer: When the surgeon performs breast biopsy through the skin, select from among four codes:

• 19100 -- Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure): APC 0004

• 19101 -- ... open, incisional: APC 0028

• 19102 -- ... percutaneous, needle core, using imaging guidance: APC 0005

• 19103 -- ... percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance: APC 0037.

If the surgeon performs more than one biopsy, you would reflect this by using modifier 59 (Distinct procedural service).

Example: The surgeon performs percutaneous biopsy for two separate lesions on the same breast. In this case, you should report 19102 for the first biopsy and 19102-59 for the second biopsy (which occurs at a separate anatomical location on the same breast).

In most cases, if the surgeon performs a breast biopsy, he will extract only a small portion of the lesion. For this reason, you likely won’t report additional codes for wound closure or skin grafts.

Finally, 19100, 19102 and 19103 include a small incision to ease the needle’s insertion into the lesion.

- Published on 2008-07-08
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