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Breast Biopsy

Pessie Posted Thu 26th of June, 2014 10:26:42 AM

We would like to clarify whether the new code 19083 for breast biopsy,is used with or without placement of clip. When med notes were requested by Optum, they rejected the 19083 stating, not supported. The submitted medical records do not contain sufficient detail to support the billed charges. The documentation does not include the placement of a breast localization device. Please advise us on how to correctly report 19083 for biopsy without placement. Thanks

SuperCoder Answered Fri 27th of June, 2014 03:53:35 AM

Thanks for your query.

Optum denial is incorrect and you may appeal the denial. Please mention the following logic in the Appeal request letter.

Code 19083 represents " Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance"

Code descriptor says - 'with placement of breast localization device when performed and imaging of the biopsy specimen, when performed'. It means that localization device placement and specimen imaging are not required for this code, but they are included if performed.

Thanks !!

Pessie Posted Mon 30th of June, 2014 16:34:31 PM

Is there a more appropriate code that should be billed for breast biopsy since ultra sound guidance was performed?

SuperCoder Answered Tue 01st of July, 2014 05:25:36 AM

No, 19083 is the correct code. It's descriptor includes the use of ultrasound guidance.

Thanks !!

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