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The procedure described by CPT® Code 19287 involves the placement of a breast localization device, which can include various types such as clips, metallic pellets, wires/needles, or radioactive seeds. This procedure is crucial for accurately identifying the location of a lesion in the breast prior to performing a biopsy or lumpectomy. The localization device serves as a marker, allowing the physician to precisely target the area of concern during surgical intervention. The use of magnetic resonance imaging (MRI) is integral to this process, as it provides a non-invasive and non-radiating method to visualize the internal structures of the breast. MRI operates by utilizing the magnetic properties of hydrogen atoms found in the body. When exposed to radio waves within a strong magnetic field, these hydrogen nuclei emit radiofrequency signals. A computer then processes these signals to generate high-resolution, three-dimensional images of the breast tissue. During the procedure, a specialized needle, which may feature metallic ringlets, contrast material, or a signal-receiving coil, is guided into the lesion under MRI guidance. This ensures accurate placement of the localization device. For wire localization, a hooked wire is inserted at a perpendicular angle to the lesion, remaining anchored within the mass once the needle is withdrawn, with a portion of the wire extending outside the skin. Alternatively, a plastic stylet with a localization device is advanced to the lesion site, where it is released before the stylet and needle are removed. This procedure is specifically coded as 19287 for the first lesion, while 19288 is used for each additional lesion that may require localization.
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The placement of a breast localization device is indicated for several specific scenarios, primarily to assist in the accurate identification and targeting of lesions within the breast prior to surgical procedures. The following conditions warrant this procedure:
The procedure for placing a breast localization device involves several detailed steps to ensure accurate placement and guidance. The following steps outline the process:
After the placement of the breast localization device, the patient may be monitored for any immediate complications. It is essential to provide post-procedure care instructions, which may include avoiding strenuous activities and monitoring the insertion site for signs of infection or unusual discomfort. The localization device will remain in place until the scheduled biopsy or lumpectomy, at which point it will assist the surgeon in accurately targeting the lesion. Follow-up imaging may be required to ensure the device remains correctly positioned prior to the surgical intervention.
| Short Descr | PERQ DEV BREAST 1ST MR GUIDE | Medium Descr | PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID | Long Descr | Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance 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 | STV-Packaged Codes | ASC Payment Indicator | Packaged service/item; no separate payment made. | 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.
| 19288 | Addon Code MPFS Status: Active Code APC N ASC N1 Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) |
| LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | 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). | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | MG | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | 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 | 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 | 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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