CPT® Code 19290

Deleted

1. Indications

The procedure described by CPT® Code 19290 is indicated for various clinical scenarios where precise localization of a breast mass is necessary prior to surgical intervention. The following conditions may warrant the use of needle localization:

• Non-palpable breast lesions - These are masses that cannot be felt during a physical examination, making imaging guidance essential for accurate targeting.
• Suspicious findings on imaging studies - Lesions that appear abnormal on mammograms or ultrasounds may require localization to confirm diagnosis through biopsy or excision.
• Guidance for surgical excision - When a mass needs to be surgically removed, localization ensures that the surgeon can accurately locate the area of concern, minimizing damage to surrounding healthy tissue.

2. Procedure

The procedure for the preoperative placement of a needle localization wire involves several critical steps to ensure accuracy and safety. The following outlines the procedural steps as described:

• Step 1: Patient Preparation The patient is positioned comfortably, and the breast area is cleaned and sterilized to reduce the risk of infection. Imaging guidance is selected based on the location and characteristics of the mass.
• Step 2: Imaging Guidance The physician utilizes imaging techniques, such as ultrasound or mammography, to visualize the targeted mass. This step is crucial for determining the precise location for needle insertion.
• Step 3: Needle Insertion A hollow needle is carefully inserted through the skin of the breast, directly over the identified mass. The physician ensures that the needle is accurately positioned to avoid any surrounding structures.
• Step 4: Guidewire Placement Once the needle is in place, a guidewire is threaded through the needle and advanced into the mass. This guidewire will serve as a marker for the surgeon during the subsequent procedure.
• Step 5: Confirmation The physician may perform additional imaging to confirm that the guidewire is correctly positioned within the mass. This step is essential to ensure that the localization is accurate before the patient is taken for surgery.
• Step 6: Dressing and Post-Procedure Care After successful placement, the needle is removed, and a dressing is applied to the insertion site. The patient is then monitored for any immediate complications before being prepared for the next steps in their treatment plan.

3. Post-Procedure

Following the placement of the needle localization wire, the patient may experience some discomfort or tenderness at the insertion site. It is important for the healthcare team to provide instructions regarding care for the site, including keeping it clean and dry. The patient will typically be scheduled for the surgical procedure to excise or biopsy the mass in a separate session. During this time, the surgical team will utilize the guidewire to accurately locate the targeted mass. Patients should be informed about potential signs of complications, such as increased pain, swelling, or signs of infection, and advised to contact their healthcare provider if these occur. Overall, the post-procedure phase is crucial for ensuring a smooth transition to the subsequent surgical intervention.