Breast biopsy procedures have evolved rapidly, but the rules that govern how they’re reported and reimbursed haven’t always kept pace. Even when the clinical work is clear, translating that work into accurate, compliant billing can be frustrating, especially when factors like imaging guidance, lesion count, laterality, and payer-specific expectations all influence how a case should be captured. Small inconsistencies can lead to denials, rework, or compliance risk, creating unnecessary administrative burden and uncertainty around what should be straightforward procedures.

In this practical, case-driven webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P, breaks down breast biopsy workflows in a way that connects what happens in the procedure room to what’s required for accurate billing. He explains current CPT and payer guidance in plain language, highlights how imaging modality drives code selection, and walks through real-world scenarios that commonly lead to errors. You’ll gain clarity on how to approach complex cases, understand what documentation truly matters, and reduce the disconnect between clinical care and billing outcomes.

Why This is Relevant:

This topic is especially important right now as scrutiny around procedure reporting and reimbursement continues to increase. With ongoing updates in payer policies, continued variation in interpretation, and growing pressure to support medical necessity and accuracy, even minor missteps can have outsized consequences. Strengthening your understanding of breast biopsy workflows today helps prevent denials, supports compliance, and ensures your work is fully and accurately represented.

Learning Objectives:

• Identify the correct CPT breast biopsy codes based on imaging guidance, lesion count, and laterality.
• Apply first-lesion and additional-lesion rules accurately, including bilateral and multimodality cases.
• Recognize bundled versus separately reportable services to prevent unintentional unbundling or missed charges.
• Interpret and apply current CMS and payer guidance affecting breast biopsy coding and reimbursement.
• Specify required documentation elements that support compliant billing, reduce denials, and withstand audits.

Who Should Attend:

Physicians, PAs, NPs performing or involved in breast biopsy procedures. Coders