Breast biopsy with clip deployment

We are using 19103 for breast biopsy with 19295 for clip deployment. We are getting clip deployment denied by Medicare. Does anyone else have this issue. It is my understanding that both procedures should be allowed.

re: Breast biopsy with clip deployment

Look it up in the CMS website, there was a change as of January 1, 2013. I believe it has to do with a staus indicator. Not 100% sure but if you search the AAPC forum there was a lengthy discussion over it there too....
Your not alone!

re: Breast biopsy with clip deployment

This is an interesting situation. Medicare changed 19295 to a TC component only when it changed the Indicator 1 to a Indicator 3 on the 2013 National Physician Fee Schedule Relative vaulue File Zero percent Update.
Since 19295 needs a base code (per CPT® 2013 Professional edition, there are 3 10022, 19102 and 19103) it is added to which ever one of those you use. If you are billing for the professional 26 side Medicare will pay for your biopsy (base code) but not the clip placement since it is now TC status only.
However, if you are billing the TC side Medicare does not pay the biopsy (base code) as it is reimbused on the professional side 26 only so without a base code on the TC side you can not get paid by Medicare for 19295. Hope this helps.

re: Breast biopsy with clip deployment

It's a packaged svc no separate pymt from MCR.