Coding for a core lymph node biopsy and a core breast biopsy with ultrasound guidance
If a patient is having an ultrasound-guided breast biopsy, CPT® code 19083, as well as an ultrasound-guided lymph node biopsy, CPT codes 76942 and 38505, is it appropriate to report all three CPT codes? Is a modifier allowed on the 76942 because it was for a different lesion?
Using the current American Medical Association (AMA) guidelines for FNA and core biopsy as a reference, we recommend reporting CPT codes 76942–59 along with code 19083 and 38505.
If you performed a core lymph node biopsy (38505) and a core breast biopsy (19083), both under US guidance, the guidance is included in the breast biopsy code, but not in the lymph node core biopsy code, therefore, you should be allowed to report the guidance of a separate lesion.
However, Medicare does have a CCI edit. The edit can be bypassed using the 59 modifier. You need to determine if you wish to take that risk. Medicare has a published policy that states guidance codes 76942, 77002, 77012, and 77021 can only be billed once per session, not per lesion. The unanswered question exists whether this policy extends to situations where the guidance is included in the breast biopsy code such as 19083 and therefore not allowed separately for the lymph node biopsy. Medicare has not provided any guidance on this specific scenario. The codes and full descriptions are as follows:
19083 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 lesion, including ultrasound guidance
76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation
38505 Biopsy or excision of lymph node(s); by needle, superficial (e.g., cervical, inguinal, axillary)