August 7, 2014
Our surgeon performed an excision of two breast masses, same incision, that were preoperatively localized with placement of wires by the breast center radiologist. Our question: do we report 19125 and 19126, or, because there was only one incision, do we only report 19125?
Thanks for your question. Based on the information provided, the correct way to report this procedure would be to report the primary procedure code 19125 and the add-on code, 19126.
CPT code 19125 is described in the 2014 CPT Manual as follows:
“Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion”
There are two key pieces of information in this definition to ensure accurate code selection:
- The lesion is identified by a radiological marker
- The code states “single lesion”
CPT code 19126, an add-on code, states, “each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure).”
Because CPT code 19125 describes a single lesion, you will report 19125 for the first radiologically marked lesion and use the add-on code 19126 for each additional radiologically marked lesion.