Percutaneous Image-Guided Breast Biopsy (NCD 220.13) – Medicare Advantage Policy Guideline Author: UnitedHealthcare Subject: This policy addresses percutaneous stereotactic or ultrasound image-guided biopsy for breast lesions. Applicable Procedure Codes: 19081, 19082, 19083, 19084, 19085, 19086. Created Date: 5/26/2021 3:36:59 PM
Unspecified lump in breast. ICD-10-CM N63.10 is grouped within Diagnostic Related Group (s) (MS-DRG v38.0): 600 Non-malignant breast disorders with cc/mcc. 601 Non-malignant breast disorders without cc/mcc. Convert N63.10 to ICD-9-CM.
A percutaneous biopsy is performed on a single breast mass with placement of a clip using ultrasound guidance. A percutaneous breast biopsy is performed of a right outer quadrant mass in the left breast with stereotactic guidance and of a second lesion in the left lower quadrant of the left breast with ultrasound guidance.
There are two types of breast biopsy codes in the breast section of the CPT Manual. A physician can perform a biopsy either percutaneously or as an open procedure. Biopsies involve the removal of differing amounts of tissue for diagnosis and different methods.
CR10622: Add ICD-10 dx N63. 10, N63. 20 unspecified quadrant, effective 10/1/18.
“When a breast biopsy is performed using both stereotactic and tomosynthesis imaging guidance, it is appropriate to use CPT code 19081, Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first ...
B3.4aBiopsy procedures B3. 4a Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic. The qualifier Diagnostic is used only for biopsies.
Coding Percutaneous Breast BiopsiesPlacement of Localization Device with ImagingCPT Code DescriptionGuidanceFirst LesionPlacement of breast localization device [s] [e.g., clip, metallic, pellet, wire/needle radioactive seeds], percutaneousMammographic19281Stereotactic19283Ultrasound192851 more row
19081If a percutaneous breast biopsy is performed using both stereotactic and tomosynthesis imaging guidance, CPT 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 ...
CPT codes 19120 and 19125 are used for excision of breast lesions, where attention to surgical margins and assurance of complete tumor resection is unnecessary.
Definition. Thoracic percutaneous needle aspiration (TPNA) and core biopsy are both minimally invasive procedures in which samples are obtained through the skin with a fine-bore hollow needle or coring needle.
When looking up 'Biopsy' in the ICD-10-PCS Alphabetic Index, it directs you to root operations drainage and excision with a diagnostic 6th character qualifier. Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic.
A core needle biopsy uses a long, hollow tube to obtain a sample of tissue. Here, a biopsy of a suspicious breast lump is being done. The sample is sent to a laboratory for testing and evaluation by doctors who specialize in analyzing blood and body tissue (pathologists).
CPT 19125 the lesion is identified by preoperative placement of radiological marker. 19301 is a partial mastectomy or lumpectomy. There is also NO radiological marker placement.
A needle localization partial mastectomy is the removal of a breast mass using radiology (imaging) tests to guide the procedure. Only the area of suspicious tissue is removed, not the whole breast. Needle localization is used when a breast mass is found on a mammogram or ultrasound, but cannot be felt by your provider.
Report both code 19285, Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance, and code 19125, Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion.
If two lesions are biopsied using different imaging modalities, whether in the same or opposite breast, two base codes are assigned, one for each modality utilized. The add-on codes may be assigned only when the same modality is utilized for separate and distinct lesions in the same breast.
Percutaneous breast biopsies can be performed utilizing various techniques, including needle core, stereotactic, rotating biopsy device, or vacuum assisted (eg, Mammotome). Ultrasound, MRI, and stereotactic guidance typically are employed to perform breast biopsies, so the new codes address only these imaging modalities.
Previously independent diagnostic testing facilities could bill for the imaging guidance of percutaneous breast procedures, but most contractors will not permit them to bill for the new comprehensive codes. Currently, there is no authoritative guidance from the CMS to address this problem.
In the rare instance where clip removal is performed as a stand-alone procedure, it should be reported with the unlisted code 19499 since there isn’t a specific code for this procedure.
There are no breast biopsy procedure codes for mammographic- or CT-guided procedures, and payer guidelines should be consulted prior to code submission if these services are performed. One option for CT-guided procedures would be to assign 19499 and 77012.
Biopsies from a separate lesion can be coded separately, so it’s important that the physician documentation clearly defines each separate lesion. The National Correct Coding Initiative (NCCI) edits bundle the following procedures and codes into 19081 to 19086: • fine-needle aspirations (10021 and 10022);
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
09/2002 - Added section that implements new policy that covers percutaneous image-guided breast biopsy. Effective and implementation dates 01/01/2003. ( TN 159 ) (CR 2232)
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.
Blue Cross Blue Shield of North Dakota (BCBSND) has identified an increase in providers billing CPT 19499, Unlisted Procedure, Breast. Review of medical records identified 19499 was being used for breast biopsies performed with stereotactic and tomosynthesis image guidance.
While reimbursement is considered, payment determination is subject to, but not limited to:
Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.
Biopsies involve the removal of differing amounts of tissue for diagnosis and different methods. Report breast biopsies using CPT codes 19100-19103.
Furthermore, what is breast biopsy with needle localization? Needle localization is a procedure done prior to a breast biopsy or breast surgery to locate a breast abnormality that can be seen on a mammogram, but cannot be felt. It is also used to verify the location of an already diagnosed breast cancer.
Percutaneous image-guided breast biopsy is a method of obtaining a breast biopsy through a percutaneous incision by employing image guidance systems. Image guidance systems may be either ultrasound or stereotactic.
Medicare covers percutaneous image guided breast biopsy using stereotactic or ultrasound imagin g for palpable lesions that are difficult to biopsy using palpation alone. UnitedHealthcare has the discretion to decide what types of palpable lesions are difficult to biopsy using palpation.