From differentiating between biopsy and partial mastectomy to reporting image-guided biopsies, including placement of radiological markers, coding for breast procedures is nothing short of mind-bending at times. And the Centers for Medicare & Medicaid Services’ (CMS’) recent changes to breast-related CPT and ICD-10 codes doesn’t make your job any easier either.
Best bet: The trick to accurately coding breast procedures is being able to dissect the documentation to look for key terms. You absolutely must have a solid understanding of anatomy, notes healthcare coding expert Jan Rasmussen in her ProfEdOnDemand webinar, “Best Practices for Coding Breast Procedures.” And, of course, you need to stay up-to-date on any coding changes that come about.
Pay Attention to Recent Coding Changes
There have been several important code revisions for breast procedures, according to the Association of Community Cancer Centers. For instance, the 2018 Medicare final regulations added the new procedure code 19294 – Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure).
Also, Medicare deleted procedure code 0301T – Destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance.
What’s more: CMS replaced mammogram codes G0202, G0204, and G0206 with procedure codes 77065, 77066, and 77067 to describe both analog and digital mammography exams, according to MSN Healthcare Solutions.
Start Using New Diagnosis Codes
Brace yourself: You also have changes to ICD-10 codes to keep in mind. CMS deleted N63 – Unspecified breast lump from the National Coverage Determination (NCD) for percutaneous image guided breast biopsy (CPT codes 19081 through 19086) and mammograms, MSN noted. CMS did not add to the list of covered diagnoses N63.10 – Unspecified lump in the right breast, unspecified quadrant and N63.20 – Unspecified lump in the left breast, unspecified quadrant.
According to the American College of Obstetricians and Gynecologists, CMS added the following more anatomically specific ICD-10 codes for breast lump:
- 11 – Unspecified lump in right breast, upper outer quadrant;
- 12 – Unspecified lump in right breast, upper inner quadrant;
- 13 – Unspecified lump in right breast, lower outer quadrant;
- 14 – Unspecified lump in right breast, lower inner quadrant;
- 21 – Unspecified lump in left breast, upper outer quadrant;
- 22 – Unspecified lump in left breast, upper inner quadrant;
- 23 – Unspecified lump in left breast, lower outer quadrant;
- 24 – Unspecified lump in left breast, lower inner quadrant;
- 31 – Unspecified lump in axillary tail of the right breast;
- 32 – Unspecified lump in axillary tail of the left breast;
- 41 – Unspecified lump in right breast, subareolar; and
- 42 – Unspecified lump in left breast, subareolar.
Crucial: Because these new ICD-10 codes are so much more specific than the old ones you were used to, you must ensure that the documentation includes both laterality and quadrant, according to MSN.
Quick Tip: Master Breast Biopsy Coding
Strategy: When you’re attempting to choose the appropriate CPT code for breast biopsies, you must base your selection on the technique used, according to the American College of Radiology (ACR). So, if you’re coding the biopsy of a palpable breast lesion, you would use CPT code 19100 for a percutaneous needle core biopsy when imaging guidance is not required.
You would report codes:
- 19081-19086 for image-guided breast biopsies, including the placement of localization devices.
- 19281-19288 for the placement of image-guided localization devices without image-guided biopsy. When more than one biopsy or localization device placement is performed using the same imaging modality, use an add-on code (if using a different imaging modality, report another primary code for each additional biopsy or localization device placement performed).
- 19081, 19083, or 19085 for the initial biopsy for bilateral image-guided breast biopsies.
- 19082, 19084, or 19086 for the contralateral and each additional breast image-guided biopsy.
Bottom line: Coding for breast procedures is no easy task – and your job keeps getting harder as CMS makes procedure and ICD-10 codes more and more specific. Learn more ways to master breast procedure coding from Rasmussen in her information-packed educational session.
