How To Use CPT Code 19081

CPT 19081 refers to a percutaneous breast biopsy procedure performed under stereotactic guidance, which may include the placement of breast localization devices and imaging of the biopsy specimen. This article will cover the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 19081.

1. What is CPT 19081?

CPT 19081 is a medical code used to describe a percutaneous breast biopsy procedure performed under stereotactic guidance. This procedure may involve the placement of breast localization devices, such as clips or metallic pellets, and imaging of the biopsy specimen. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 19081 CPT code description

The official description of CPT code 19081 is: “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.”

3. Procedure

1. The provider identifies the breast lesion using stereotactic guidance.
2. A small incision is made in the skin over the lesion.
3. The provider inserts a needle or other instrument through the incision to obtain a tissue sample from the lesion.
4. If necessary, the provider places a breast localization device, such as a clip or metallic pellet, at the biopsy site.
5. The provider may image the biopsy specimen, if required.
6. Pressure and bandages are applied to the incision site to control bleeding and promote healing.

4. Qualifying circumstances

Patients eligible to receive CPT 19081 services are those with suspicious breast lesions that require a biopsy for further evaluation. This may include patients with abnormal mammogram or ultrasound findings, palpable breast masses, or other clinical indications that warrant a breast biopsy. The procedure is typically performed under stereotactic guidance to ensure accurate targeting of the lesion and minimize the risk of complications.

5. When to use CPT code 19081

CPT code 19081 should be used when a percutaneous breast biopsy is performed under stereotactic guidance, with or without the placement of breast localization devices and imaging of the biopsy specimen. This code is applicable for the first lesion biopsied during the procedure. If additional lesions are biopsied using the same imaging modality, an add-on code should be used, such as +19082 for each additional lesion.

6. Documentation requirements

To support a claim for CPT 19081, the following information should be documented in the patient’s medical record:

• Indication for the breast biopsy, such as abnormal imaging findings or clinical suspicion of malignancy.
• Description of the stereotactic guidance technique used to identify the lesion.
• Details of the biopsy procedure, including the type of needle or instrument used and the number of tissue samples obtained.
• Placement of breast localization devices, if performed, and the type of device used.
• Imaging of the biopsy specimen, if performed, and the imaging modality used.
• Post-procedure care, including pressure and bandaging of the incision site.

7. Billing guidelines

When billing for CPT 19081, it is important to follow the appropriate guidelines and rules to ensure accurate reimbursement. This code includes stereotactic guidance and applies to the first lesion biopsy. If additional lesions are biopsied using the same imaging modality, an add-on code should be used, such as +19082 for each additional lesion. If different imaging modalities are used for additional biopsies, report another primary code for each additional modality. Do not separately bill for imaging codes 76098, 76942, 77002, or 77021 for the same lesion.

8. Historical information

CPT 19081 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Similar codes to CPT 19081

Five similar codes to CPT 19081 include:

• CPT 19082: This add-on code is used for each additional lesion biopsied under stereotactic guidance using the same imaging modality.
• CPT 19083: This code describes a percutaneous breast biopsy with placement of breast localization devices and imaging of the biopsy specimen, when performed, using ultrasound guidance.
• CPT 19084: This add-on code is used for each additional lesion biopsied under ultrasound guidance using the same imaging modality.
• CPT 19085: This code describes a percutaneous breast biopsy with placement of breast localization devices and imaging of the biopsy specimen, when performed, using magnetic resonance (MR) guidance.
• CPT 19086: This add-on code is used for each additional lesion biopsied under MR guidance using the same imaging modality.

10. Examples

Here are 10 detailed examples of CPT code 19081 procedures:

1. A 45-year-old woman with a suspicious mammogram finding undergoes a percutaneous breast biopsy under stereotactic guidance, with placement of a clip at the biopsy site.
2. A 55-year-old woman with a palpable breast mass undergoes a percutaneous breast biopsy under stereotactic guidance, with imaging of the biopsy specimen.
3. A 60-year-old woman with a history of breast cancer undergoes a percutaneous breast biopsy under stereotactic guidance for a new suspicious lesion, with placement of a metallic pellet at the biopsy site.
4. A 50-year-old woman with an abnormal ultrasound finding undergoes a percutaneous breast biopsy under stereotactic guidance, without placement of a localization device or imaging of the biopsy specimen.
5. A 40-year-old woman with a family history of breast cancer undergoes a percutaneous breast biopsy under stereotactic guidance for a suspicious lesion, with placement of a clip and imaging of the biopsy specimen.
6. A 65-year-old woman with a suspicious mammogram finding undergoes a percutaneous breast biopsy under stereotactic guidance, with placement of a metallic pellet and imaging of the biopsy specimen.
7. A 48-year-old woman with a palpable breast mass undergoes a percutaneous breast biopsy under stereotactic guidance, with placement of a clip at the biopsy site and imaging of the biopsy specimen.
8. A 52-year-old woman with an abnormal ultrasound finding undergoes a percutaneous breast biopsy under stereotactic guidance, with placement of a metallic pellet at the biopsy site.
9. A 57-year-old woman with a history of breast cancer undergoes a percutaneous breast biopsy under stereotactic guidance for a new suspicious lesion, without placement of a localization device or imaging of the biopsy specimen.
10. A 62-year-old woman with a suspicious mammogram finding undergoes a percutaneous breast biopsy under stereotactic guidance, with placement of a clip at the biopsy site and imaging of the biopsy specimen.