I am enclosing an article from the coding institute to help you. Please note this is a 2009 article so please omit 2009 values.
Sidestep common unit mishaps like a pro -- we’ll show you how.
Breast biopsy coding choices add up pretty quickly because your radiologist has options for various biopsy and imaging methods. And you may have to determine whether she performed clip placement, too. But you can nail stereotactic breast biopsy coding every time with these three easy to implement steps.
1. Use Key Words to Separate 19102 and 19103
When your radiologist performs a stereotactic breast biopsy, you first need to determine which biopsy code to report. You’ll have to decide between 19102 (Biopsy of breast; percutaneous, needle core, using imaging guidance) and 19103 (… percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance) based on the documentation your radiologist provides.
How to choose: "The difference between 19102 and 19103 is that 19102 is only the needle core biopsy using imaging," explains Karen Caputo, CCS-P, certified coder for the University of Toledo Physicians in Ohio. You’ll see the radiologist use a different device (also with imaging) for 19103.
19102: You’ll use 19102 when your physician documents that he simply inserts the device and then pulls out a core of tissue, says Laura Singleton, billing specialist at the Center for Surgery & Breast Health in Joliet, Ill. Keep in mind that your physician may make several "passes" in order to ensure that he has obtained a sufficient sample for pathology, Singleton adds.
Key: For both 19102 and 19103, report one unit per lesion -- not per sample -- unless your payer tells you otherwise in writing.
19103: Code 19103, like 19102, reflects a percutaneous procedure, but for 19103 the physician uses a "more sophisticated device that has suction or a rotating action to obtain the sample," Singleton explains.
For example, the radiologist may use a Mammotome device, which vacuums, cuts, and removes tissue samples.
"Generally 19103 is the code to use for stereotactic biopsies because of the automated vacuum assisted or rotating device that is used," says Pat McCullough, CPC, in the billing/coding department at Spring Ridge Surgical Specialists in Wyomissing, Penn.
Boost Biopsy Coding With NCD Know-How
Medicare’s national coverage determination (NCD) for "Percutaneous Image-Guided Breast Biopsy (220.13)" states, "Medicare covers percutaneous image-guided breast biopsy using stereotactic or ultrasound imaging for a radiographic abnormality that is nonpalpable and is graded as a BIRADS III [probably benign], IV [suspicious abnormality], or V [highly suggestive of malignant neoplasm]."
The NCD also states that "Medicare covers percutaneous image guided breast biopsy using stereotactic or ultrasound imaging for palpable lesions that are difficult to biopsy using palpation alone. Contractors have the discretion to decide what types of palpable lesions are difficult to biopsy using palpation."
Don’t overlook: Payers may add additional helpful guidelines, such as "When multiple lesions are involved; billing is dependent on the location of the lesion and the number of lesions. Documentation in the patient’s progress notes must indicate that the separate lesions are independent of each other, and that each biopsy is medically necessary." You can find this in the WPSIC document "Percutaneous Image-Guided Breast Biopsy" (RAD-028) available at www.wpsic.com/medicare/part_b/policy/rad028.pdf.
2. Capture an Extra $195 for 77031
For the "stereotactic" part of a stereotactic breast biopsy, look to code 77031 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation). Note that you may report 77031 for "each lesion."
This code has 5.4 global transitioned facility relative value units (RVUs). Multiply that by the 2009 conversion factor (36.0666), and you see that Medicare offers roughly $195 for the global service. Even if you bill only the professional service (modifier 26, Professional component), you’ll receive roughly $80 (2.25 RVUs).
What it is: For stereotactic imaging, the radiologist takes images from two angles to visualize the biopsy path for the needle. The patient may be face down on a special, raised table which has an opening for the breast, allowing the radiologist to perform the biopsy from beneath the patient. Or the radiologist may use upright stereotactic imaging instead, particularly to biopsy the axilla of the breast. For upright imaging, the patient must sit in a chair or lie on her side.
Watch for: Sometimes radiologists work with a surgeon for stereotactic biopsies. The surgeon performs and reports the biopsy (19103) and the radiologist will report the guidance (77031).
3. Watch for Other Reportable Services, Too
If the radiologist performs a breast biopsy with clip placement, don’t forget to report +19295 (Image-guided placement, metallic localization clip, percutaneous, during breast biopsy).
Tip: If the radiologist performs the breast biopsy using stereotactic guidance, payers include a follow-up mammogram in the guidance codes. So if the radiologist performs a follow-up mammogram to confirm clip placement, you should not report the mammo-gram separately.
Code 19102, Biopsy of breast; percutaneous, needle core, using imaging guidance, and code 19103, percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance, are reported based on the number of sampled lesions, not the number of obtained samples taken for pathological analysis.
Since malignant cells may be found in one area of a lesion but not in another, multiple passes into the same lesion may be taken in order to ensure that the lesion is appropriately evaluated. For example, if one lesion was sampled three times, the breast biopsy code 19102 would be reported once.
If ultrasound guidance was used for this breast biopsy procedure, then it would be appropriate to report code 76942, in addition to the breast biopsy code. Although the descriptors for codes 19102 and 19103 state "using imaging guidance," the guidance is reported separately (see the cross-reference notes below these codes). Code 76942 includes any preliminary ultrasound performed to confirm the lesion and plan an optimal biopsy approach, on the same day.