Evan Posted Tue 29th of January, 2019 15:18:17 PM
We have a dispute regarding proper coding for a New 3D Tomosynthesis breast biopsy procedure. The radiology department has been submitting based upon the following based upon vendor provided information: If Tomosynthesis is used for positioning and targeting, pre- and post-fire check, and post-biopsy, the correct CPT code to report for 3D-only guided biopsy is CPT 19499 – Unlisted procedure, breast. A description for the unlisted procedure, such as “Tomosynthesis Guided Breast Biopsy” should be included on the claim. Reimbursement for 19499 is Carrier Priced and will be determined based on the physician’s report.
• If Tomosynthesis is used for positioning and stereotactic imaging is used for pre- and post-fire check, and an additional tomosynthesis “sweep” is taken post-biopsy, then the correct CPT code to report for the 3D/2D biopsy procedure is CPT 19081. We believe the following is accurate based upon ACR and a 2016 Supercoder question that was answered: The appropriate codes should be:
CPT-77061 is the unilateral breast tomosynthesis code
CPT-19081 (single lesion) add 19082 (if additional lesions)
SuperCoder Answered Wed 30th of January, 2019 07:01:39 AM
Please note that unlisted code should only be used when there is no CPT code/s for the procedure/s performed. Here we have codes for tomosynthesis and also codes for breast biopsy, which are as follows:
77061 Digital breast tomosynthesis, unilateral
77062 Digital breast tomosynthesis, bilateral
77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to 77065 or 77066.
CPT codes 77061 and 77062 may not be used for CMS claims. We have a HCPCS code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)) should be used for reporting tomosynthesis for CMS patients.
HCPCS code 77063, must be billed in conjunction with the primary service mammogram code 77067.
Breast biopsy should be reported separately with code 19081 (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 stereotactic guidance).
Please feel free to write if you have any question.