CPT code 19282 is used for the placement of a percutaneous device in the breast, each with imaging guidance.
CPT code 19282 is used to describe the placement of a percutaneous device for breast biopsy, each additional lesion, including imaging guidance. This code is typically used when a healthcare provider needs to perform a biopsy on an additional breast lesion beyond the first one, and it includes the use of imaging techniques such as ultrasound, mammography, or MRI to guide the procedure.
When using CPT code 19282, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component
- Use this modifier when the service provided is the professional component only, such as the interpretation of imaging.
2. Modifier TC - Technical Component
- Apply this modifier when the service provided is the technical component only, such as the use of imaging equipment.
3. Modifier 50 - Bilateral Procedure
- This modifier is used if the procedure is performed on both breasts during the same session.
4. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same session.
5. Modifier 52 - Reduced Services
- Apply this modifier if the procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure is repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure is repeated by a different physician.
10. 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 returns to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 99 - Multiple Modifiers
- Use this modifier when multiple modifiers are necessary to describe the service provided.
These modifiers ensure accurate billing and reimbursement by providing additional context about the procedure performed. Always verify payer-specific guidelines as they may have unique requirements or restrictions.
Determining whether CPT code 19282 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 19282 is reimbursed, you would need to check the MPFS database. This can be done through the Centers for Medicare & Medicaid Services (CMS) website or by using specialized software that accesses this data. Additionally, the MAC for your region may have specific guidelines or local coverage determinations (LCDs) that could affect reimbursement for this code.
In summary, to determine if CPT code 19282 is reimbursed by Medicare, you should review the MPFS and consult with your regional MAC for any specific coverage policies.
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