How To Use CPT Code 19120

CPT 19120 is a code used for the excision of cysts, fibroadenomas, or other benign or malignant tumors in the breast, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 19120?

CPT 19120 is a medical procedure code used to describe the excision of cysts, fibroadenomas, or other benign or malignant tumors, aberrant breast tissue, duct lesions, nipple or areolar lesions in male or female patients using an open approach. This code is utilized by healthcare providers to accurately document and bill for this specific surgical procedure.

2. 19120 CPT code description

The official description of CPT code 19120 is: “Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions.”

3. Procedure

The 19120 procedure involves the following steps:

1. The patient is appropriately prepped and placed under local or general anesthesia.
2. An incision is made on the skin above the lesion to access the abnormal tissue.
3. The incision is taken down to deep tissues, and fascia and muscle are dissected away from their attachment to the diseased tissue.
4. The abnormal tissue is excised and carefully removed from the breast.
5. Bleeding is controlled with electrocautery.
6. The wound is closed in layers.
7. Additional lesions may be excised if necessary.
8. A drainage catheter may be left in place for some time to enhance healing.

4. Qualifying circumstances

Patients eligible to receive CPT code 19120 services are those who have one or more suspicious breast lesions, such as cysts, fibroadenomas, or other benign or malignant tumors, aberrant breast tissue, duct lesions, nipple or areolar lesions. The decision to perform this procedure is based on factors such as the patient’s medical history, physical examination, and imaging studies, as well as the risk the tumor presents to the patient.

5. When to use CPT code 19120

It is appropriate to bill the 19120 CPT code when a healthcare provider performs the excision of one or more suspicious breast lesions using an open approach. This code should be used for both male and female patients, regardless of the number of lesions excised during the same session.

6. Documentation requirements

To support a claim for CPT 19120, the following information should be documented:

• Patient’s medical history and physical examination findings
• Imaging studies, such as mammograms or ultrasounds, confirming the presence of the lesion(s)
• Indication for the procedure, including the risk the tumor presents to the patient
• Details of the surgical procedure, including the incision site, excision of the lesion(s), and wound closure
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 19120, keep in mind the following guidelines:

• If a lesion is removed from both breasts, apply modifier 50 for the bilateral procedure.
• If two different procedures are performed on the left and right breasts, add the LT and RT modifiers to the appropriate procedure codes. Modifier 59 for a distinct procedural service may also be required in the case of different procedures on different breasts. Check with the payer to avoid denials and resubmissions.

8. Historical information

CPT 19120 was added to the Current Procedural Terminology system on January 1, 1990. There have been several updates to the code since its introduction:

• Code Changed on 01-01-2001
• Code Changed on 01-01-2007
• Code Changed on 01-01-2010

9. Similar codes to CPT 19120

Five similar codes to CPT 19120 and how they differentiate are:

• CPT 19110: This code is used for the excision of a solitary lactiferous duct or a papilloma lactiferous duct during nipple exploration.
• CPT 19112: This code is used for the excision of a lactiferous duct fistula, which is a tract between the duct and the skin.
• CPT 19125: This code is used for the excision of breast lesions identified by preoperative placement of a radiological marker, with or without partial mastectomy.
• CPT 19300: This code is used for mastectomy for gynecomastia, which is the removal of breast tissue in males.
• CPT 19301: This code is used for partial mastectomy, which is the removal of a portion of the breast tissue, including the tumor and some surrounding tissue.

10. Examples

Here are 10 detailed examples of CPT code 19120 procedures:

1. Excision of a single breast cyst in a female patient using an open approach.
2. Excision of multiple fibroadenomas in a male patient using an open approach.
3. Excision of a benign tumor and a duct lesion in the same breast during the same session.
4. Excision of a malignant tumor in one breast and a benign tumor in the other breast during the same session.
5. Excision of a nipple lesion in a female patient using an open approach.
6. Excision of an areolar lesion in a male patient using an open approach.
7. Excision of aberrant breast tissue in a female patient using an open approach.
8. Excision of a duct lesion and a nipple lesion in the same breast during the same session.
9. Excision of multiple cysts in both breasts during the same session.
10. Excision of a malignant tumor and a benign tumor in the same breast during the same session.