Cheryl Posted Thu 19th of December, 2019 13:51:03 PM
My doctor performed an intraoperative placement of needle localization to the right breast mass under ultrasound guidance. She the excised the mass and placed it in the Faxitron to ensure removal of the entire mass which was a fibroadenoma. She then went into the same incision and excised a posterior duct lesion which was an intraductal papilloma. I'm thinking this would be 19120 and 76098,26. Would this be correct?
SuperCoder Answered Fri 20th of December, 2019 04:44:25 AM
Thank you for your question.
As per the above documentation excision with placement of needle localization using ultrasonic guidance was used hence CPT® code 19125-RT seems most appropriate.
In this procedure, the provider accesses the aberrant tissue or lesion through an open incision over the breast at the site indicated by the marker. She carries the incision down to the depth of the marker. She excises the lesion and its surrounding tissue and cauterizes the vessels to prevent bleeding.
Radiological marker placement is one method in which a needle/wire is inserted with the help of radiological guidance (e.g. ultrasound, mammography, MRI, stereotactic imaging) and put into position at the exact location of the tumor.
In CPT® code 19120, the provider excises aberrant breast tissue such as a cyst, tumor, or fibroadenoma. She makes an incision on the skin above the lesion to access the abnormal tissue. There is no utilization of any radiological marker, i.e. wire/needle to indicate the site. If above stated procedure performed without needle localization then only CPT code 19120 would be appropriate. Kindly correlate with your operative report before billing codes.
Hope this helps!
Cheryl Posted Fri 20th of December, 2019 08:22:26 AM
I'm a bit confused by your reply as 19125 is preoperative not intraoperative. Would this be considered preoperative as the wire was inserted just prior to the incision? The operative report began would the usual sterile prep and drape then continued with the needle localization and excision. Would it then be more appropriate to use 19285? That however would bundle with 19120.
SuperCoder Answered Tue 24th of December, 2019 04:12:33 AM
CPT code 19285 is a percutaneous approach-based code. The provided documentation indicates that the open procedure was performed. The needle localization was performed to the right breast mass under ultrasound guidance before the excision of the entire was, which was a fibroadenoma.
Since, the needle placement with ultrasound guidance was performed along with excision, so we have a more specific code; i.e. 19125 (this code includes needle placement with mass excision). It will not be appropriate to report two separate codes for procedure(s): placement of breast localization and excision of fibroadenoma.
Note: Would this be considered preoperative as the wire was inserted just prior to the incision?
Yes, radiological marker placement is one method in which a needle/wire is inserted with the help of radiological guidance (e.g. ultrasound, mammography, MRI, stereotactic imaging) and put into position at the exact location of the tumor.
Hope this helps!