Overview of CPT Code 19083
CPT code 19083 refers to an ultrasound-guided breast biopsy, including placement of localization devices and imaging when performed. It involves percutaneous needle placement under real-time ultrasound for precise tissue sampling, typically for the first lesion.
1.1. Definition and Purpose
CPT code 19083 is defined as a breast biopsy procedure performed under ultrasound guidance. It involves the percutaneous placement of a needle into a breast lesion, guided by real-time ultrasound imaging, to obtain tissue samples for pathological examination. The purpose of this code is to report the initial biopsy of a single breast lesion using ultrasound imaging. It also includes the placement of a breast localization device (e.g., a clip or metallic pellet) when necessary, as well as imaging of the biopsy area if performed. This procedure is minimally invasive and is primarily used to diagnose suspicious breast abnormalities, such as lesions or masses, identified during imaging studies like mammography or ultrasound.
1.2. Key Points About the Procedure
CPT code 19083 is specifically used for the ultrasound-guided biopsy of a single breast lesion. The procedure involves real-time ultrasound imaging to guide the needle into the target lesion, ensuring accuracy and minimizing tissue damage. It is a percutaneous procedure, meaning the needle is inserted through the skin without the need for a surgical incision. The code also includes the placement of a localization device, such as a clip or marker, if performed during the biopsy. This device helps in identifying the location of the lesion for future reference or additional procedures. Additionally, imaging of the biopsy area, when performed, is included in this code. The procedure is typically outpatient and is considered less invasive compared to surgical biopsies, offering quicker recovery times for patients. Accurate coding is essential to ensure proper reimbursement for this diagnostic service.
When to Use CPT Code 19083
CPT code 19083 is used for the ultrasound-guided biopsy of a single breast lesion. It applies to the initial percutaneous needle placement under real-time ultrasound imaging for the first lesion.
2.1. Ultrasound-Guided Breast Biopsy for the First Lesion
CPT code 19083 is specifically used for an ultrasound-guided breast biopsy of the first lesion. This procedure involves percutaneous needle placement under real-time ultrasound imaging, ensuring precise tissue sampling. It is performed to evaluate suspicious breast abnormalities identified during imaging. The code applies to the initial biopsy of a single lesion, making it essential for accurate diagnosis. If additional lesions are biopsied, separate codes such as 19084 are required. This method is minimally invasive and offers high accuracy due to ultrasound guidance. The procedure may include placement of a localization device, such as a clip, to mark the biopsy site for future reference. CPT code 19083 is appropriate when imaging confirms a single lesion requiring tissue sampling. It is a critical tool in diagnosing breast conditions, ensuring timely and precise patient care.
2.2. Percutaneous Needle Placement Under Real-Time Ultrasound Imaging
Percutaneous needle placement under real-time ultrasound imaging is a key component of CPT code 19083. This technique involves guiding a needle through the skin into the breast tissue using ultrasound visualization, ensuring accurate targeting of the lesion. Real-time imaging allows the physician to monitor the needle’s trajectory, enhancing precision and minimizing complications. The procedure is performed under local anesthesia, making it a minimally invasive option for patients. The use of ultrasound guidance enables direct visualization of the needle entering the lesion, ensuring a precise biopsy sample. This method is particularly useful for lesions that are not easily palpable or are located in areas difficult to access. The real-time imaging capability reduces the risk of procedural errors and improves diagnostic accuracy, making it a preferred approach for image-guided breast biopsies. This technique is integral to the application of CPT code 19083 for the first lesion biopsy.
Related CPT Codes
- 19084: For additional lesions biopsied during the same session.
- 19085: Includes placement of a localization device.
- 76642: Ultrasound guidance for the procedure.
- 77065/77066: Diagnostic mammography, unilateral or bilateral.
3.1. CPT Code 19084 for Additional Lesions
CPT code 19084 is used for ultrasound-guided breast biopsy of additional lesions beyond the first one. This code applies when percutaneous needle placement is performed under real-time ultrasound imaging for each additional lesion. It is reported separately from the primary procedure (CPT 19083) and is billed per additional lesion. For example, if a patient has multiple lesions in the same breast or separate lesions in the contralateral breast, 19084 is used for each subsequent lesion. This ensures accurate billing for multiple biopsies performed during the same session. The code does not include placement of a localization device unless specified separately. Always verify documentation for the number of lesions biopsied to ensure correct coding.
3.2. CPT Code 19085 for Localization Device Placement
CPT code 19085 is specifically used for the placement of a breast localization device, such as a clip, metallic pellet, or wire, under ultrasound guidance; This code is reported separately when a localization device is placed during a breast biopsy procedure. It is often used in conjunction with other biopsy codes like 19083 or 19084 but should not be billed separately if the placement is included in the primary procedure. For example, if a localization device is placed in a single lesion during an ultrasound-guided biopsy, 19085 is reported in addition to the biopsy code. This ensures accurate billing for the placement of a marker to guide future treatment, if necessary. Always check documentation to confirm the placement of a localization device and its billing requirements.
3.3. CPT Code 76642 for Ultrasound Guidance
CPT code 76642 is used to report ultrasound guidance for breast procedures, such as biopsies or aspirations. It is typically billed separately from the primary biopsy code, such as 19083, to account for the imaging component. This code captures the real-time ultrasound imaging provided during the procedure to guide needle placement accurately. For example, if a physician uses ultrasound to direct the biopsy needle, 76642 is reported in addition to the biopsy code. This ensures reimbursement for both the procedure and the imaging guidance. It is essential to document the use of ultrasound guidance during the procedure to support the use of this code. Always verify payer policies, as some may bundle imaging guidance with the primary procedure, requiring careful billing practices.
3.4. CPT Codes 77065/77066 for Diagnostic Mammography
CPT codes 77065 and 77066 are used for reporting diagnostic mammography services. These codes are essential when a mammogram is performed to evaluate a specific symptom or abnormality, such as a palpable mass or suspicious imaging findings. 77065 applies to unilateral diagnostic mammography, while 77066 is used for bilateral diagnostic mammography. These codes are often utilized in conjunction with other breast biopsy codes, such as 19083 for ultrasound-guided biopsies, to ensure comprehensive reporting of imaging services. It is important to note that these codes should not be used for screening mammograms, which are reported with different codes, such as Z12.31. Proper documentation of the mammography’s purpose and laterality is crucial for accurate billing. Always verify payer guidelines to ensure compliance with specific reporting requirements for diagnostic mammography services.
Billing Guidelines
Ensure accurate billing by using appropriate modifiers and documenting laterality. Follow NCCI and payer-specific guidelines. Verify correct CPT code usage for unilateral or bilateral procedures to avoid claim denials and ensure proper reimbursement.
4.1. Correct Usage of Modifiers
Correct use of modifiers is crucial for accurate billing. Modifier 26 is used for the professional component, typically by radiologists. Modifier 50 denotes bilateral procedures, while LT and RT specify laterality for unilateral cases. Modifier 76 is applied for repeat procedures, ensuring proper documentation of additional biopsies. Accurate modifier usage prevents claim denials and ensures appropriate reimbursement for ultrasound-guided breast biopsies.
4.2. Reporting Multiple Lesions and Bilateral Procedures
For multiple lesions, CPT code 19083 is used for the first lesion, and 19084 is reported for each additional lesion in the same or contralateral breast. Bilateral procedures require separate coding for each breast. Use modifier 50 for bilateral cases or LT/RT for unilateral procedures to specify laterality. Each lesion beyond the first must be documented with a separate code to ensure accurate billing. Proper reporting prevents claim denials and ensures correct reimbursement for ultrasound-guided breast biopsies, whether unilateral or bilateral.
Clinical Scenarios
Clinical scenarios include single lesion biopsy, multiple lesions in the same breast, and lesions in both breasts. Each case requires specific coding to ensure accurate billing, proper documentation, and reimbursement.
5.1. Single Lesion Biopsy
A single lesion biopsy under ultrasound guidance is the most common scenario for using CPT code 19083. This procedure involves percutaneous needle placement to collect tissue from a single suspicious lesion in the breast. The use of real-time ultrasound ensures precise targeting of the lesion, minimizing the risk of complications. This code applies when only one lesion is biopsied, and no additional lesions are sampled during the same session. If multiple lesions are present, separate coding for each additional lesion is required, typically using CPT code 19084. Accurate documentation of the number of lesions and the imaging guidance used is essential for correct billing. This scenario is straightforward and represents the primary application of CPT code 19083 in clinical practice.
5.2. Multiple Lesions in the Same Breast
When multiple lesions are identified in the same breast, CPT code 19083 is used for the initial lesion, and CPT code 19084 is reported for each additional lesion biopsied during the same procedure. This distinction ensures accurate billing, as each lesion beyond the first requires separate documentation. The use of ultrasound guidance remains consistent across all lesions, providing precise targeting for tissue sampling. It is important to note that each additional lesion must be clearly documented in the patient’s records to justify the use of multiple codes. This approach ensures that both the primary and secondary lesions are accounted for in the billing process, reflecting the complexity and extent of the procedure accurately. Proper coding in such scenarios is essential to avoid reimbursement issues and maintain compliance with billing guidelines.
5.3. Lesions in Both Breasts
When lesions are present in both breasts, separate CPT codes are used for each breast. For the first lesion in each breast, CPT code 19083 is reported. If additional lesions are biopsied in either breast, CPT code 19084 is used for each subsequent lesion. This ensures accurate billing for bilateral procedures. Ultrasound guidance is applied to each breast independently, and the placement of localization devices, if performed, is included in the primary code for each breast. Documentation must clearly specify the number of lesions in each breast and whether localization devices were placed. For example, if two lesions are biopsied in the left breast and one in the right, 19083 and 19084 would be reported for the left, and 19083 for the right. This distinction ensures proper reimbursement and compliance with coding guidelines.
Documentation Requirements
Accurate documentation is critical for CPT code 19083. Include details like the number of lesions, ultrasound guidance use, and localization device placement. Detailed records ensure proper billing and compliance with coding standards.
6.1. Importance of Detailed Reporting
Detailed reporting is essential for accurate billing and compliance when using CPT code 19083. Proper documentation ensures that all aspects of the ultrasound-guided breast biopsy are recorded, including the number of lesions, use of ultrasound guidance, and placement of localization devices. This level of detail helps prevent billing errors and audits. Additionally, clear documentation supports continuity of patient care by providing a comprehensive record of the procedure for future reference. It is crucial to include specifics about the imaging techniques used and any additional procedures performed during the biopsy. Without thorough documentation, claims may be denied, and reimbursement delayed. Therefore, healthcare providers must prioritize precise and complete reporting to maintain integrity in billing and patient care.
6.2. Necessary Components for Accurate Billing
Accurate billing for CPT code 19083 requires specific components to be documented. These include the number of lesions biopsied, the method of imaging guidance used (e.g., ultrasound), and whether localization devices were placed. The procedure must clearly distinguish between unilateral and bilateral procedures, as this affects coding. Additionally, documentation should specify whether the biopsy was primary or subsequent, as this impacts the use of related codes like 19084. The use of modifiers, such as 26 for professional services, must also be noted. Detailed records of the patient’s medical history, imaging results, and the procedure’s outcomes are essential. Proper coding ensures timely reimbursement and compliance with payer policies. Missing or incomplete information can lead to claim denials, emphasizing the need for thorough and precise documentation. This ensures that all billed services are justified and accurately reflected in the patient’s records.