CPT code 19086 is for an additional breast biopsy lesion using MRI guidance.
CPT code 19086 is used to describe an additional biopsy of a breast lesion that is guided by magnetic resonance imaging (MRI). This code is specifically for each additional lesion that is biopsied during the same session as the primary procedure. It ensures that healthcare providers can accurately document and bill for the extra work involved in examining multiple lesions in one visit.
For CPT code 19086, which pertains to a breast biopsy involving an additional lesion using magnetic resonance imaging (MRI), the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, such as the interpretation of the MRI images and the performance of the biopsy.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed, such as the use of the MRI equipment and the technical staff involved in the procedure.
3. Modifier 50 - Bilateral Procedure: This modifier is used if the biopsy is performed on both breasts during the same session.
4. Modifier 52 - Reduced Services: This modifier is used if the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the biopsy of the additional lesion is a distinct service from other procedures performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same physician performs the biopsy procedure more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician performs the biopsy procedure more than once on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient needs to return for an additional biopsy procedure related to the initial one during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the biopsy of the additional lesion is unrelated to the initial procedure performed during the postoperative period.
10. Modifier 99 - Multiple Modifiers: This modifier is used when more than four modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
Determining whether CPT code 19086 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 19086 is reimbursed, you would need to check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, MACs, which are regional contractors responsible for processing Medicare claims, may have specific local coverage determinations (LCDs) that could affect reimbursement for this code.
Therefore, to confirm the reimbursement status of CPT code 19086, you should review the MPFS and consult with your regional MAC for any specific guidelines or restrictions that may apply.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 19086. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and maximize your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
