As discussed last month, new category III codes that could impact your interventional radiology coding services are now effective as of January 1, 2022. With these codes now active, interventional radiology providers and stakeholders should be aware of the scope of changes in place for the new year. New code 0644T mentioned in last month’s insight, has a significant amount of detail for correct coding and comprehension. By knowing the rationale, staff and coders can prepare for a successful year while safeguarding compliance.
So, what do the breast biopsy codes include? Breast biopsy codes include the following components:
Understand that guidance, localization device placement, and/or imaging of the removed specimen should not be separately coded when associated with a percutaneous biopsy.
It no longer matters whether the biopsy is performed using a rotating or vacuum-assisted device; instead, the code choice depends on the type of guidance. These codes may be used even when a localization device is not placed, or a surgical specimen is not x-rayed because the code description indicates “if performed.”
Frequently, a clip is placed at the biopsy site after a percutaneous biopsy. These clips can be seen under radiographic imaging and are placed in case other intervention is later required. The clip indicates the location of the biopsy site. Clip placement is included in the percutaneous breast biopsy codes when performed by the same physician at the same session.
There are several types of guidance including:
For each type of guidance, there is a code for first lesion and another for each additional lesion. The “each additional lesion” code would be assigned for a second lesion biopsied using the same type of guidance, whether in the same or opposite breast as the first lesion.
Understand that it is not appropriate to report an initial lesion code with modifier 50 for biopsy of bilateral lesions using the same type of guidance. Coding would be the same if a single lesion is biopsied in each breast or if two lesions in one breast are separately biopsied using the same type of guidance. If bilateral lesions or two lesions in one breast are separately biopsied using different types of guidance, assign the appropriate “first lesion” code for each.
For example, if a lesion in the right breast is biopsied using ultrasound guidance, and a separate lesion in the same breast must be biopsied under MRI guidance, you would submit codes 19083 and 19085. However, if separate lesions in the left and right breast are both biopsied using ultrasound guidance, codes 19083 and 19084 would be reported.
| 19081 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance |
| +19082 | Biopsy, breast, with placement of breast localization device(s) (e.g., 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) |
| 19083 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance |
| +19084 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) |
| 19085 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance |
| +19086 | Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) |
There is no longer a code for mammographic guidance for needle placement. If a percutaneous breast biopsy is performed under mammographic guidance, the unlisted surgical code 19499 should be assigned. Code 19499 also should be reported if CT guidance is used for a percutaneous breast biopsy.
| 19499 | Unlisted procedure, breast
Note that if a percutaneous breast biopsy is performed without imaging guidance, code 19100 would be appropriate. |
| 19100 | Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) |
So how is aspiration biopsy coded? Aspiration biopsy of the breast is coded using the appropriate generic FNA code (10021, 10004-10012). Note that coders sometimes have trouble deciding between an FNA and breast cyst aspiration (19000-19001). The FNA code would be assigned when the intent of the procedure was to obtain a sample of cells or fluid for diagnostic evaluation, even if the lesion was a cyst. Code 19000 is assigned if the intent was to drain a cyst, even if the aspirated material is sent to the lab for cytologic evaluation.
Explore more topics, crack through the complexity of interventional radiology, and master more coding through expert-infused tips by using our Essentials of Interventional Radiology Coding resource. Create success for 2022 and beyond.
Information source for breast biopsy statistic:
https://www.cbsnews.com/news/breast-biopsies-often-get-it-wrong/
Healthcare has been transitioning toward a more digital, interconnected ecosystem for many years, but the pace and magnitude of current changes represent a fundamental shift.
H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
