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Guidance only for new 2014 breast procedures

Kelly Posted Thu 23rd of January, 2014 12:10:17 PM

With the new 2014 breast procedures guidance is bundled. In 2013 if mammo guidance was provided for another physician doing the biopsy you could coded 77032-26-52. For 2014 how can you code for the guidance?

Kelly Posted Fri 24th of January, 2014 07:12:45 AM

does anyone know how to code guidance only for breast procedures???????

SuperCoder Answered Fri 24th of January, 2014 08:22:52 AM

From Coding alert :

Confirm imaging guidance to get to the right codes.

2014 brings in new codes for breast biopsy that will require you to count lesions biopsied and also to confirm what imaging guidance your radiologist used. Here is how you can acquaint yourself of these changes and prepare for flawless reporting of breast procedures.

Count the Lesions

“2014 will offer you three new codes for breast biopsy using localization devices,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc.

“The new codes were created by the Relative Value Scale Update Committee’s (RUC) Relativity Assessment Workgroup (RAW) based on procedures which are performed together most (75%) of the time,” says Christy Hembree, CPC, Team Leader, Summit Radiology Services, Dallas, TX. “You assign the codes based on the type of guidance utilized and the number of lesions.” These codes are structured much like the placement of the localization device codes. They too require the use of a primary CPT® and add-on code for each additional lesion.

Important: Codes 19081, 19083, and 19085 are for percutaneous biopsy of the first lesion in the breast. “You select CPT® codes 19081, 19083, and 19085 for the first lesion based on the imaging modality,” says Hembree. For each additional lesion biopsied, you report codes +19082 (……..each additional lesion, including stereotactic guidance [List separately in addition to code for primary procedure]), +19084 (……each additional lesion, including ultrasound guidance [List separately in addition to code for primary procedure]), +19086 (…………each additional lesion, including magnetic resonance guidance [List separately in addition to code for primary procedure]) for stereotactic, ultrasound, or MRI guidance, respectively.

Remember: CPT® codes +19082, +19084 and +19086 are add-on codes and will only be reported in addition to the primary procedure code.

Practical benefits: The new codes will help to simplify your breast biopsy reporting. “The new codes are all inclusive,” says Hembree. “Currently, Part B Medicare does not reimburse for a clip placement (CPT® 19295) when performed in an outpatient hospital setting (POS 22); this policy typically inflates the practice’s AR. We hope the new codes will balance things out.”

Nix These Biopsy Codes in 2014

Next year, biopsy codes get more specific in the number of lesions and imaging used. “Coders will no longer have to choose their codes according to the type of biopsy, i.e. needle core or vacuum-assisted, which should simplify the coding process,” says Hembree.

Note that CPT® will delete the following breast biopsy codes effective Jan. 1, 2014:

19102 (Biopsy of breast; percutaneous, needle core, using imaging guidance)
19103 (Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance)
Besides biopsy codes, the following codes for breast procedures will also be deleted in 2014.

19290 (Preoperative placement of needle localization wire, breast)
+19291 (Preoperative placement of needle localization wire, breast; each additional lesion [List separately in addition to code for primary procedure])
+19295 (Image guided placement, metallic localization clip, percutaneous, during breast biopsy/aspiration [List separately in addition to code for primary procedure])
77031 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation)
77032 (Mammographic guidance for needle placement, breast [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) 

Kelly Posted Fri 24th of January, 2014 20:07:51 PM

I know what all of the new codes are..............My question is if ONLY guidance is being provided for another doctor who is performing the breast procedure can that be coded. Example 2013 mammo guidance provided ONLY then 77032-26-52 would be coded.

SuperCoder Answered Mon 27th of January, 2014 11:10:34 AM

These services were combined into a single code because they are performed together more than 75% of the time. Because the payer expects to see the single code for the service, the surest route is to check the payer’s preference for how to report. Two possibilities include:

1. The physician performing needle placement should report the complete procedure and work out a payment agreement with the physician providing guidance (following any legal requirements that may be involved).

2. Each physician may report the code with modifier 52. However payers may deny the second claim as duplicate or will want an explanation for why two physicians are reporting the same code on the same date for the same patient.

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