How To Use CPT Code 19294

CPT code 19294 describes the preparation of a tumor cavity and the placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with a partial mastectomy. 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 19294?

CPT 19294 is used to describe the preparation of a tumor cavity and the placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) during the same session as a partial mastectomy. This code is used when a provider prepares the site from which the tumor was removed and places a small applicator in the surgical bed to deliver low energy radiation.

2. Official Description

The official description of CPT code 19294 is: ‘Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure).’

3. Procedure

After performing a partial mastectomy, the provider prepares the site from which the tumor was removed for the placement of an applicator to deliver intraoperative radiation therapy (IORT). This may involve enlarging the cavity if necessary and controlling any bleeding. The provider then places a small applicator in the surgical bed from where the tumor was removed. Low energy radiation is delivered through the applicator. The applicator may be removed or left in place for additional postoperative targeted radiotherapy. Finally, the provider completes the partial mastectomy.

4. Qualifying circumstances

CPT 19294 is indicated for early stage breast cancer and is used to avoid damage to healthy tissue caused by external radiation therapy administered to a wider area. It is performed during the same session as a partial mastectomy.

5. When to use CPT code 19294

CPT code 19294 should be used when a provider performs the preparation of a tumor cavity and places a radiation therapy applicator for intraoperative radiation therapy (IORT) during the same session as a partial mastectomy. It should be reported in addition to the primary procedure code for the partial mastectomy.

6. Documentation requirements

To support a claim for CPT 19294, the provider must document the following information:

• Patient’s diagnosis and indication for intraoperative radiation therapy (IORT)
• Details of the preparation of the tumor cavity
• Placement of the radiation therapy applicator
• Delivery of low energy radiation through the applicator
• Any additional postoperative targeted radiotherapy
• Completion of the partial mastectomy

7. Billing guidelines

When billing for CPT 19294, ensure that the procedure is performed during the same session as a partial mastectomy. Report this code in addition to the primary procedure code for the partial mastectomy. There are no specific guidelines regarding reporting CPT 19294 with other codes.

8. Historical information

CPT 19294 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Similar codes to CPT 19294

Five similar codes to CPT 19294 include:

• CPT 19281: Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)
• CPT 19282: Mastectomy, radical, including pectoral muscles, with or without axillary lymph nodes
• CPT 19283: Mastectomy, modified radical, including axillary lymph nodes, with or without pectoral muscle removal
• CPT 19284: Mastectomy, subcutaneous
• CPT 19298: Mastectomy, other than radical, including axillary lymph nodes

9. Examples

1. A provider performs a partial mastectomy and prepares the tumor cavity for the placement of a radiation therapy applicator for intraoperative radiation therapy (IORT).
2. During a partial mastectomy, a provider places a radiation therapy applicator in the surgical bed to deliver low energy radiation for intraoperative radiation therapy (IORT).
3. After performing a partial mastectomy, a provider enlarges the tumor cavity and places a radiation therapy applicator for intraoperative radiation therapy (IORT).
4. A provider completes a partial mastectomy and places a radiation therapy applicator in the surgical bed to deliver low energy radiation for intraoperative radiation therapy (IORT).
5. During a partial mastectomy, a provider prepares the tumor cavity and places a radiation therapy applicator for intraoperative radiation therapy (IORT).
6. After performing a partial mastectomy, a provider controls bleeding and places a radiation therapy applicator in the surgical bed for intraoperative radiation therapy (IORT).
7. A provider completes a partial mastectomy and delivers low energy radiation through a radiation therapy applicator for intraoperative radiation therapy (IORT).
8. During a partial mastectomy, a provider prepares the tumor cavity and delivers low energy radiation through a radiation therapy applicator for intraoperative radiation therapy (IORT).
9. After performing a partial mastectomy, a provider places a radiation therapy applicator in the surgical bed and completes the procedure with intraoperative radiation therapy (IORT).
10. A provider completes a partial mastectomy and places a radiation therapy applicator in the surgical bed for intraoperative radiation therapy (IORT) before completing the procedure.