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Radiology Coding Alert

Take 4 Steps to Achieve Clean Claims for Breast Biopsies

One of the benefits of interventional radiology breast biopsies is quick patient recovery. Use these four steps to ensure your practice recovers their reimbursement with the same speed. Interventional radiology procedures of the breast provide a minimally invasive alternative to traditional open procedures, offer patients the option of being treated on an outpatient basis, and present patients with more choices concerning the treatment they are being administered. And coding these interventional radiology breast procedures, i.e., imaging-guided percutaneous biopsy, postbiopsy clipped appointments, cyst aspirations, etc., also presents coders with more choices, options, and coding alternatives which isn't always a good thing.

"The majority of interventional procedures require at least two CPT Codes ," says April Brazinsky, CCS, coding specialist for the Community Hospital of the Monterrey Peninsula in California in a teleconference titled "Coding to Insure Proper Pay Up for Interventional Radiology Breast Procedures." Use these steps to guide yourself through coding breast biopsies and you can be sure you won't miss out on coding all of the components for which you should be reimbursed. Step 1: Choose the Appropriate Surgical Code "It is generally easiest to first determine what is being performed," Brazinsky says. She recommends using the basic procedural descriptor, i.e., biopsy or aspiration, to begin a search in the CPT index, then choosing the appropriate modality. For a biopsy-specific example, a patient presents with a history of a nodule in her left breast, recorded by a previous mammogram. An ultrasound of the left breast confirms the presence of a nodule, and the patient and radiologist decide to carry forward with an ultrasound-guided core biopsy with a 14-gauge needle. Three separate cores are taken and submitted to pathology.

To choose the appropriate procedure code, first narrow your choices to only those codes representing a biopsy of the breast:
19100* Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)
19101 open, incisional
19102 percutaneous, needle core, using imaging guidance
19103 percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance.   Of the possible breast biopsy codes, you can exclude 19100 and 19101 because the descriptors don't account for "ultrasound-guided" biopsies, those performed under ultrasonic guidance, a form of imaging guidance. Code 19101 can also be excluded because it represents an open rather than a percutaneous biopsy. Radiology practices typically won't encounter code 19100 because it does not require imaging guidance, Brazinsky says.

The procedure description did not mention the use of a vacuum or rotating device, so you can also exclude CPT code 19103. You have narrowed your search down to one code and should report code 19102 to represent [...]

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