Radiology Question for the Week of November 8, 2021

Question:

If a patient is having an ultrasound-guided breast biopsy, codes 19083, as well as an ultrasound-guided lymph node biopsy, 76942, 38505, is it appropriate to code all three codes? Is a modifier allowed on the 76942 since it was for a different lesion?

Answer:

Using the current American Medical Association (AMA) guidelines for FNA and core biopsy as a reference, I would report 76942-59 along with codes 19083 and 38505. If you performed a core lymph node biopsy (38505) and a core breast biopsy, both under US guidance, the guidance is included in the breast biopsy code, but not in the lymph node core biopsy code, so you should be able to report it for the guidance of a separate lesion. However, Medicare does have a CCI edit. It can be bypassed with 59 modifier, so 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 question exists whether this policy extends to situations where the guidance is included in the procedure code
such as 19083 and not billed separately.

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