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A percutaneous breast biopsy is a minimally invasive procedure that allows for the sampling of breast tissue to diagnose potential abnormalities. This procedure is guided by stereotactic imaging, which employs a fixed coordinate system to accurately locate the lesion within the breast. The process begins with the cleansing of the skin and the administration of a local anesthetic to ensure patient comfort. Stereotactic guidance involves the use of imaging technology to pinpoint the lesion's precise location by defining it in three-dimensional coordinates relative to a reference point. During the procedure, the breast is positioned between a compression plate and a support structure, which stabilizes the lesion for accurate targeting. The thickness of the breast under compression is a critical factor in determining the depth of the lesion. An initial imaging study is performed at a perpendicular angle to the compression plate, which helps to center the lesion within the biopsy window. Subsequent images are taken at various angles to further refine the location of the lesion through geometric calculations. If a needle biopsy is indicated, a needle is carefully inserted into the lesion to obtain a tissue sample. Typically, multiple core needle insertions—ranging from three to six—are necessary to ensure that an adequate sample is collected for analysis. Once the tissue sample is secured, it is sent to a laboratory for pathological examination. In cases where an automated vacuum-assisted or rotating biopsy device is utilized, the procedure involves making a small incision in the skin and placing a breast probe at the lesion site. The device then uses suction to draw tissue into its sampling chamber, or a rotating cutting mechanism is employed to capture tissue samples. This process may involve taking between eight to ten samples, with the probe being repositioned at approximately 30-degree intervals. After the sampling is completed, pressure is applied to the biopsy site to minimize bleeding. Additionally, a metallic localization clip or pellet may be placed at the biopsy site to assist in future surgical procedures, such as a lumpectomy, by marking the exact location of the tissue removal. The procedure concludes with the removal of the biopsy needle and the potential acquisition of additional images of the biopsy specimen for further evaluation.
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The percutaneous breast biopsy procedure is indicated for the evaluation of various breast abnormalities. These may include:
The procedure for a percutaneous breast biopsy with stereotactic guidance involves several critical steps to ensure accurate tissue sampling. First, the patient is positioned appropriately, and the breast is placed between a compression plate and a support structure to stabilize the area of interest. The skin over the biopsy site is then cleansed with an antiseptic solution, and a local anesthetic is injected to minimize discomfort during the procedure. Following this, stereotactic imaging is utilized to obtain an initial image of the breast at a perpendicular angle to the compression plate. This image serves as a reference point to center the lesion within the biopsy window. Subsequent images are captured at various angles, allowing for precise geometric calculations to determine the lesion's three-dimensional coordinates. Once the lesion is accurately located, a biopsy needle is inserted into the lesion to collect tissue samples. Typically, three to six core needle insertions are performed to ensure that sufficient tissue is obtained for pathological analysis. If an automated vacuum-assisted or rotating biopsy device is employed, a small incision is made, and a breast probe is inserted at the lesion site. The device uses suction to draw tissue into its sampling chamber, or a rotating cutting mechanism is utilized to capture tissue samples. This process may involve taking eight to ten samples, with the probe being repositioned at approximately 30-degree intervals to ensure comprehensive sampling. After the tissue samples are collected, they are sent to a laboratory for pathological examination. If a localization clip or pellet is indicated, the biopsy needle is left in place, and a plastic stylet with the clip or pellet is inserted through the needle and advanced to the biopsy site using imaging guidance. The clip or pellet is then released, and both the stylet and needle are removed. Finally, additional images of the biopsy specimen may be obtained to assist in the evaluation prior to the separate reportable pathology examination.
After the completion of the percutaneous breast biopsy, the patient is monitored for any immediate complications, such as bleeding or discomfort at the biopsy site. Pressure is applied to the area to minimize bleeding, and the patient may be advised to avoid strenuous activities for a short period. Instructions regarding care of the biopsy site, including keeping it clean and dry, are provided. Patients are typically informed about potential side effects, such as bruising or swelling, which may occur but usually resolve within a few days. Follow-up appointments may be scheduled to discuss the results of the pathological examination and to determine any further necessary actions based on the findings.
| Short Descr | BX BREAST 1ST LESION STRTCTC | Medium Descr | BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID | Long Descr | Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1A - Major procedure - breast | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 19082 | Addon Code MPFS Status: Active Code APC N ASC N1 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | GC | This service has been performed in part by a resident under the direction of a teaching physician | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | GA | Waiver of liability statement issued as required by payer policy, individual case | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2014-01-01 | Added | Added |
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