How To Use CPT Code 19125

CPT 19125 refers to the excision of a single breast lesion identified by a preoperative radiological marker through an open incision. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 19125 procedures.

1. What is CPT 19125?

CPT 19125 is a medical procedure code used to describe the excision of a single breast lesion that has been identified by a preoperative radiological marker. This code is used by medical coders and billers to accurately document and bill for this specific procedure. The procedure involves the removal of the lesion and surrounding tissue through an open incision, guided by the preoperatively placed radiological marker.

2. 19125 CPT code description

The official description of CPT code 19125 is: “Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion.”

3. Procedure

The 19125 CPT code procedure involves the following steps:

1. The preoperative placement of a radiological marker at the site of the breast lesion.
2. An open incision is made over the breast at the site indicated by the marker.
3. The incision is carried down to the depth of the marker.
4. The lesion and surrounding tissue are excised.
5. Vessels are cauterized to prevent bleeding.
6. The marker is removed.
7. The wound is closed with layered sutures.
8. A drainage catheter may be left in place postoperatively for a couple of days.

4. Qualifying circumstances

Patients eligible to receive CPT code 19125 services are those with a breast lesion that has been identified by a preoperative radiological marker. This procedure is typically performed when the lesion is not palpable and requires radiological assistance for accurate localization and excision. Patients with a history of breast cancer, abnormal mammogram or ultrasound findings, or suspicious breast lumps may be candidates for this procedure.

5. When to use CPT code 19125

It is appropriate to bill the 19125 CPT code when a single breast lesion has been identified by a preoperative radiological marker and the provider performs an open excision of the lesion. This code should not be used for the placement of the localization device or for the excision of additional lesions during the same procedure. In such cases, other CPT codes should be used in conjunction with 19125.

6. Documentation requirements

To support a claim for CPT 19125, the following information should be documented:

• Patient’s medical history and physical examination findings.
• Indication for the procedure, including the presence of a breast lesion identified by a preoperative radiological marker.
• Description of the procedure, including the steps involved in the excision of the lesion and surrounding tissue.
• Details of the radiological marker placement, including the type of guidance used (e.g., ultrasound, mammography, MRI, stereotactic imaging).
• Postoperative care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 19125, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 19125 include:

• Use add-on code 19126 for each additional lesion excised during the same procedure.
• Do not include the placement of the localization device in the billing for 19125. Use codes 19281 through 19288 for the placement of localization devices in the breast.
• Ensure that all required documentation is complete and accurate to support the claim for CPT 19125.

8. Historical information

CPT 19125 was added to the Current Procedural Terminology system on January 1, 1994. The code was changed on January 1, 2001, with the previous descriptor being “Excision of breast lesion identified by preoperative placement of radiological marker; single lesion.”

9. Similar codes to CPT 19125

Five similar codes to CPT 19125 and how they differentiate from CPT 19125 are:

1. CPT 19120: 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, one or more lesions; this code is used for excision of various breast lesions without the use of a preoperative radiological marker.
2. CPT 19126: Add-on code for each additional lesion excised during the same procedure as CPT 19125.
3. CPT 19281: Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; this code is used for the placement of localization devices in the breast without the excision of the lesion.
4. CPT 19288: Removal of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; this code is used for the removal of localization devices without the excision of the lesion.
5. CPT 19301: Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy); this code is used for partial mastectomy procedures, which involve the removal of a larger portion of breast tissue than CPT 19125.

10. Examples

Here are 10 detailed examples of CPT code 19125 procedures:

1. A 45-year-old female with a history of breast cancer has a suspicious lesion identified by a preoperative radiological marker. The provider performs an open excision of the lesion using CPT code 19125.
2. A 55-year-old female with an abnormal mammogram undergoes an ultrasound-guided placement of a radiological marker at the site of a breast lesion. The provider then performs an open excision of the lesion using CPT code 19125.
3. A 60-year-old female with a palpable breast lump has a stereotactic-guided placement of a radiological marker at the site of a breast lesion. The provider performs an open excision of the lesion using CPT code 19125.
4. A 50-year-old female with a history of abnormal breast imaging findings undergoes a mammography-guided placement of a radiological marker at the site of a breast lesion. The provider then performs an open excision of the lesion using CPT code 19125.
5. A 40-year-old female with a suspicious breast lump undergoes an MRI-guided placement of a radiological marker at the site of a breast lesion. The provider performs an open excision of the lesion using CPT code 19125.
6. A 65-year-old female with a history of breast cancer has a suspicious lesion identified by a preoperative radiological marker. The provider performs an open excision of the lesion and an additional lesion using CPT code 19125 and add-on code 19126.
7. A 48-year-old female with an abnormal mammogram undergoes an ultrasound-guided placement of a radiological marker at the site of a breast lesion. The provider then performs an open excision of the lesion and an additional lesion using CPT code 19125 and add-on code 19126.
8. A 52-year-old female with a palpable breast lump has a stereotactic-guided placement of a radiological marker at the site of a breast lesion. The provider performs an open excision of the lesion and two additional lesions using CPT code 19125 and add-on code 19126 for each additional lesion.
9. A 58-year-old female with a history of abnormal breast imaging findings undergoes a mammography-guided placement of a radiological marker at the site of a breast lesion. The provider then performs an open excision of the lesion and three additional lesions using CPT code 19125 and add-on code 19126 for each additional lesion.
10. A 62-year-old female with a suspicious breast lump undergoes an MRI-guided placement of a radiological marker at the site of a breast lesion. The provider performs an open excision of the lesion and four additional lesions using CPT code 19125 and add-on code 19126 for each additional lesion.