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BREAST BIOPSY WITH NEEDLE LOCALIZATION WITH INTRAOPERAIVE ULTRASOUND

Rebecca Posted Thu 31st of October, 2019 12:41:37 PM
· Pre-operative Diagnosis: Mass, breast, right x3 · Procedure Performed: Breast biopsy, with needle localization, right,x2, with intraoperative ultrasound guidance Patient was first taken to the radiology suite where needle localization procedures were performed. -radiologist placed the guidewires. Surgery was done out patient hospital POS 22 2 masses were localized with the same guidewire and removed in the first specimen and both are visible on the specimen radiogragh.The second lesion was removed through the same incision. A total of 3 bx were taken CPT coded 19125-rt ,19126-rt,19126-59,rt.....or since 2 of then were removed through the same incision would it be CPT 19125-rt and 19126-rt. @ of the bx were with intraoperative ultrasound would the CPT code be 76882-26,rt and 76882-26,59,rt--TY for your help/clarification
SuperCoder Answered Fri 01st of November, 2019 10:49:37 AM

Hi,

Thanks for your question.

As per the limited documentation, if the radiological marker identify three different lesions then code 19125-RT, 19126-RT and 19126-RT will be coded. However, it is not documented in the provided documentation that the patient had three different lesion therefore code only 19125-RT.

Radiological marker placement is one method in which a needle/wire is inserted with the help of radiological guidance (e.g. ultrasound and put into position at the exact location of the tumor. The process commonly uses a 21–gauge Kopans localization needle. The needle is advanced under sonographic guidance and a hook–wire is inserted, advanced, and placed at the site of the tumor. In some cases, a smaller 14–gauge needle is used to place a localizing clip at the site of the tumor under sonographic guidance. The clip is normally contained in a collagen plug. This is used as guidance for excision of the tumor.

In this scenario the radiologist is using localization needle and ultrasound guidance for excision of lesion therefore, intraoperative ultrasound should not be billed.

Hope this helps.

Thanks.

Rebecca Posted Mon 04th of November, 2019 12:40:52 PM
Let me re-clarify my question. The radiologist performed the needle localization procedures" earlier that day-we are not billing for the placement of he clips. I am clarifying the coding for the physician work 1.) the physician incised a total of 3 breast biopsies, all in the right breast. 2.) two of the biopsies were done using intraoperative ultrasound guidance 3.) 2 of the biopsies were done through the same incision. 19125-rt,19126-rt, 19126,59-rt , 76998-26,rt ,76998-26,59,rt(76998 ultrasonic guidance ,intraoperative-I had used the incorrect CPT 76882 in the above question). Would this be the correct codes ?
SuperCoder Answered Tue 05th of November, 2019 07:23:52 AM

Thanks.

 

When three different radiological markers or clips are placed on three different lesion and the physician removes the lesions and markers through same incision then codes 19125-RT, 19126-RT and 19126 RT will be coded. 

 

Code 76998 is code for intraoperative ultrasound guidance with MUE of 1. Therefore, the code will be coded only once i.e. 76998-RT.

 

The codes should be

19125-RT

19126-RT x 2 units

76998-RT

 

Hope this helps.

Thanks. 

Rebecca Posted Tue 05th of November, 2019 11:20:36 AM
TY TY TY
Rebecca Posted Tue 05th of November, 2019 11:47:10 AM
ty for the clarification …… I re-reviewed the op report with the physician to make sure I was clear about the biopsies. lets try this again. 1.) 2 masses were localized with the same guidewire and removed through the same incision …… after re-reading this would this still be counted as 2 biopsies ? 19125-rt 19126-rt ? 2.) the 3rds lesion had a guidewire 19126-rt ……..I understand about 76882 having 1 mue so it can only be billed once. So the 1st and the 2nd biopsy had the same guidewire through it ...so there was a total of 2 guidewires placed but 3 biopsies . TY
SuperCoder Answered Wed 06th of November, 2019 08:38:16 AM

Hi,

Since 2 guidewires were used for 3 biopsies therefore codes will be 19125-RT, 19126-RT. Also code 76998 instead of 76882 for intraoperative ultrasound guidance.

Hope this helps.

 

Rebecca Posted Thu 07th of November, 2019 12:10:13 PM
TY
SuperCoder Answered Fri 08th of November, 2019 00:24:13 AM

Thank you, happy to help.

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