Coding for bilateral cyst aspirations

Q.

When performing bilateral breast cyst aspirations, do we report CPT^® codes 19000 and 19001 or CPT code 19000 x 2? 

A.

The AMA’s guidance from the 1994 Fall edition of the CPT Assistant states if two cysts in the same breast are aspirated, then you report CPT codes 19000 and 19001; however, if one cyst from each breast are aspirated, then report CPT code 19000 with modifier 50, bilateral. That said, the reporting rules can be different by payor. The AMA has changed the guidelines for other CPT add-on codes regarding “each additional” code to mean the same side or opposite side and many payors are interpreting this guideline for all CPT add-on codes. However, the AMA has no specific guideline that changes their original guidance from 1994 regarding CPT codes 19000 and 19001. Of note, Medicare has an MUE of 2 for CPT code 19000 “due to anatomic consideration.” This leads us to believe that Medicare still follows the AMA guidance to report CPT code 19001 only when you are performing multiple cyst aspirations in the same breast. 

The codes and full descriptions are as follows:

19000 Puncture aspiration of cyst of breast

19001 Each additional cyst (List separately in addition to code for primary procedure)