How To Use CPT Code 19100

CPT code 19100 describes the percutaneous, needle core biopsy of the breast without using imaging guidance. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 19100?

CPT 19100 is a code used to describe the percutaneous, needle core biopsy of the breast without using imaging guidance. This procedure involves the removal of a core tissue sample from a breast lesion for diagnostic purposes, such as determining the presence of breast cancer.

2. Official Description

The official description of CPT code 19100 is: ‘Biopsy of breast percutaneous, needle core, not using imaging guidance (separate procedure).’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider makes a small incision using a needle.
3. The provider removes tissues from the breast lesions using a core biopsy needle.
4. Pressure is applied to the site to control any bleeding.

4. Qualifying circumstances

CPT 19100 is performed when there is a need to obtain a tissue sample from a breast lesion for diagnostic purposes. This procedure is typically used to test for the presence of breast cancer. It is important to note that CPT 19100 is a separate procedure and should not be reported separately when performed as part of a larger related service.

5. When to use CPT code 19100

CPT code 19100 should be used when a percutaneous, needle core biopsy of the breast is performed without using imaging guidance. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 19100, the following documentation is required:

• Indication for the biopsy and the need for diagnostic testing
• Description of the procedure performed, including the use of a core biopsy needle
• Date of the procedure
• Any additional relevant information, such as the size or location of the breast lesion
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 19100, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, consider the following billing guidelines:

• If the provider performs biopsy on more than one site on the same side, report the subsequent biopsies with modifier 59.
• If the provider performs percutaneous biopsy of the breast and fine needle aspiration (FNA) at the same site, do not report CPT 19100 and CPT 10021 together. To report CPT 19100 and CPT 10021 together, the sites need to be different.

8. Historical information

CPT 19100 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a percutaneous, needle core biopsy of a breast lesion without using imaging guidance to determine the presence of breast cancer.
2. A provider performs a separate procedure of percutaneous, needle core biopsy of the breast without using imaging guidance to obtain a tissue sample for diagnostic testing.
3. A patient undergoes a percutaneous, needle core biopsy of a breast lesion without using imaging guidance as part of a larger related service.
4. A provider performs a percutaneous, needle core biopsy of a breast lesion without using imaging guidance and applies pressure to control bleeding.
5. A patient undergoes a percutaneous, needle core biopsy of a breast lesion without using imaging guidance to test for the presence of breast cancer.
6. A provider performs a separate procedure of percutaneous, needle core biopsy of the breast without using imaging guidance to obtain a tissue sample for diagnostic testing.
7. A patient undergoes a percutaneous, needle core biopsy of a breast lesion without using imaging guidance as part of a larger related service.
8. A provider performs a percutaneous, needle core biopsy of a breast lesion without using imaging guidance and applies pressure to control bleeding.
9. A patient undergoes a percutaneous, needle core biopsy of a breast lesion without using imaging guidance to test for the presence of breast cancer.
10. A provider performs a separate procedure of percutaneous, needle core biopsy of the breast without using imaging guidance to obtain a tissue sample for diagnostic testing.