How To Use CPT Code 19126

CPT code 19126 describes the excision of an additional breast lesion that has been previously identified by a preoperative radiological marker. 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 19126?

CPT 19126 is used to describe the excision of an additional breast lesion that has been previously identified by a preoperative radiological marker. This code is used when the provider removes an aberrant tissue or lesion through an open incision over the breast, using the preoperatively placed radiological marker as a guide.

2. Official Description

The official description of CPT code 19126 is: ‘Excision of breast lesion identified by preoperative placement of radiological marker, open each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure).’ It is important to note that intraoperative placement of clips is not separately reported.

3. Procedure

The procedure for CPT code 19126 involves the following steps:

1. The provider accesses the additional aberrant tissue or lesion through an open incision over the breast at the site indicated by the preoperative radiological marker.
2. The provider carries the incision down to the depth of the marker.
3. The provider excises the lesion and its surrounding tissue.
4. The provider cauterizes the vessels to prevent bleeding.
5. The provider removes the preoperative radiological marker.
6. The provider closes the wound with layered sutures.
7. A drainage catheter may be left in place postoperatively for a couple of days.

4. Qualifying circumstances

CPT 19126 is used when there is a need to excise an additional breast lesion that has been previously identified by a preoperative radiological marker. This code is used in conjunction with the primary procedure code, CPT 19125. It is important to note that the intraoperative placement of clips is not separately reported.

5. When to use CPT code 19126

CPT code 19126 should be used when the provider is performing an excision of an additional breast lesion that has been previously identified by a preoperative radiological marker. This code should be reported in addition to the primary procedure code, CPT 19125.

6. Documentation requirements

To support a claim for CPT 19126, the provider must document the following information:

• The need for excision of the additional breast lesion identified by the preoperative radiological marker
• The specific details of the excision procedure, including the incision site and depth
• The excised lesion and its surrounding tissue
• The cauterization of vessels to prevent bleeding
• The removal of the preoperative radiological marker
• The closure of the wound with layered sutures
• Any postoperative instructions or use of a drainage catheter

7. Billing guidelines

When billing for CPT 19126, it is important to report this code in addition to the primary procedure code, CPT 19125. The intraoperative placement of clips should not be separately reported. It is important to follow the specific guidelines provided by the payer regarding the use of modifiers or any additional documentation requirements.

8. Historical information

CPT 19126 was added to the Current Procedural Terminology system on January 1, 1994. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider excising an additional breast lesion that has been previously identified by a preoperative radiological marker after removing an initial lesion from the same breast.
2. A surgeon removing an aberrant breast tissue through an open incision using a preoperatively placed radiological marker as a guide.
3. A radiologist performing an excision of a breast lesion that has been previously identified by a preoperative radiological marker using percutaneous techniques and stereotactic guidance.
4. A breast surgeon excising multiple breast lesions that have been previously identified by preoperative radiological markers through open incisions.
5. A provider removing a nipple or areolar lesion that has been previously identified by a preoperative radiological marker through an open incision.
6. A surgeon excising a fibroadenoma from the breast using a preoperatively placed radiological marker as a guide.
7. A radiologist performing a percutaneous excision of a breast lesion using ultrasound guidance and a preoperatively placed radiological marker.
8. A breast surgeon removing multiple cysts from the breast that have been previously identified by preoperative radiological markers through open incisions.
9. A provider excising an aberrant breast tissue using a preoperatively placed radiological marker as a guide and closing the wound with layered sutures.
10. A surgeon removing a benign or malignant tumor from the breast that has been previously identified by a preoperative radiological marker through an open incision.