2025 CPT code 19100
Effective Date: N/A Surgery - Surgical Procedures on the Integumentary System Feed
Percutaneous needle core biopsy of breast without imaging guidance.
Modifiers, such as -59 (Distinct Procedural Service), may be applicable in specific situations. For example, if biopsies are performed on distinct lesions within the same breast, modifier -59 would be appended to 19100 for the second and subsequent biopsies.
Medical necessity for 19100 must be supported by the presence of a palpable breast abnormality requiring tissue diagnosis. Documentation should clearly indicate the clinical rationale for the procedure and why imaging guidance was not necessary.
In simple words: A small tissue sample is taken from a breast lump using a needle to check for problems like breast cancer. This is done without using imaging like ultrasound or mammography to guide the needle.
This procedure involves removing a core tissue sample from a breast lesion using a needle, without the use of imaging guidance, for diagnostic purposes, such as testing for breast cancer. After preparing and anesthetizing the patient, the provider makes a small incision and inserts a core biopsy needle to remove the tissue sample. Pressure is applied to control bleeding.
Example 1: A patient presents with a palpable breast lump. A core needle biopsy is performed without imaging guidance to obtain a tissue sample for diagnosis., A patient has a suspicious area identified on a mammogram, but it is easily palpable. A core needle biopsy (19100) is performed without imaging guidance due to the lump's accessibility., A patient previously had a fine needle aspiration (FNA) of a breast lump, which yielded inconclusive results. A core needle biopsy (19100) is performed without imaging guidance to collect a larger tissue sample for more definitive testing.
Documentation should include a description of the lesion, the location of the biopsy, the method used (needle core biopsy), the number of samples taken, and any complications encountered. Confirmation that imaging guidance was not used is crucial for proper coding.
- Specialties:Breast surgery, general surgery, surgical oncology
- Place of Service:Office, Hospital, Ambulatory Surgical Center, and other outpatient settings.