needle localization of breast lesion and excision

two breast lesions had pre-operative placement of needle localization wires
and would be coded:19290 for the first lesion and +19291 for the second
lesion and then had excision of both of the needle localized lesion BUT
both of the lesions were excised through the same excision and the ? is
how is this excision coded

Thanks

re: needle localization of breast lesion and excision

[two breast lesions had pre-operative placement of needle localization wires
and would be coded:19290 for the first lesion and +19291 for the second
lesion and then had excision of both of the needle localized lesion BUT
both of the lesions were excised through the same excision and the ? is
how is this excision coded

Thanks]

re: needle localization of breast lesion and excision

There is no black and white answer. Some suggest coding both excisions with -52 on 2nd lesion Some suggest only one excision code because 1 incision. Both were marked and had to be in close proximetry to each other if one incision. Were they excised in one specimen? or did each require separate tissue excision. This is why an operative report is essential for accurate coding. Others suggest coding both lesion excision. If both required separate tissue excisions code both.

re: needle localization of breast lesion and excision

I thought my description was quite clear and stated it was 2 lesions
through 1 excision and I always code from the operative report.
If the 2nd lesion is coded the code is +19126 and I believe that a
modifier cannot be used. Is that correct? Could you please let me
know where I can get an answer?

Thank you

re: needle localization of breast lesion and excision

From a CPT® coding perspective and in the absence of a specific operative note, if a lesion identified by preoperative placement of a radiological marker is excised, then CPT® code 19125, Excision of breast lesion identified by preoperative placement of radiological marker; single lesion, would be reported for the first lesion. If more than one lesion identified by preoperative placement of a radiological marker is excised, then code 19126, Excision of breast lesion identified by preoperative placement of radiological marker; each additional lesion separately identified by a radiological marker, would be reported for the excision of each additional lesion.
In this example, if a lesion identified by preoperative placement of a radiological marker is removed from the left breast and 2 lesions identified by preoperative placement of a radiological marker are removed from the right breast, code 19125 would be reported for the lesion on the left breast. CPT® code 19125 and 19126 would be reported for the two lesions that were excised on the right breast. It is important to note that the modifier -51, Multiple Procedures, should not be appended to code 19126 as it is an add-on code.