Ask Dr. Z

Mammo/tomo biopsy is new to me, is one or the other guidance the deciding factor for code selection? Medicare is denying 19081 as not medically necessary.

Patient is seen for a tomosynthesis guided biopsy of calcifications in the 9 o'clock position of the right breast at a posterior depth. The patient's right breast was positioned and digital tomosynthesis images of calcifications in the 9 o'clock position of the right breast at a posterior depth were obtained. The lesion to be biopsied was localized, marked and targeted. The skin was prepped. 1% lidocaine was used for local anesthesia. A 9 gauge  EVIVA probe was inserted from a lateral approach and advanced into the tissue.  Core samples were then obtained. A total of 5 core specimens were obtained.

Digital specimen radiograph confirmed the presence of calcification in the core samples.

CONCLUSION: Successful tomosynthesis guided core needle biopsy of calcifications in the 9 o'clock position of the right breast at a posterior depth.