Ask Dr. Z

I know there's official guidance that states if both stereotactic AND tomo are used to only report 19081, and if it's just tomo to report 19499. What code would you consider for this excerpt below? I'm getting confused when a report states, "Mammo guided WITH tomo."

"TECHNIQUES: Patient was placed sitting upright and erect.  FINDINGS: Mammographically guided with tomosynthesis core needle biopsies of calcifications in the upper-outer quadrant of the anterior left breast. This was done with aseptic technique and local anesthesia, 1 percent lidocaine with bicarbonate. The breast was compressed in the CC projection and biopsy was from the superior aspect of the breast. A small dermatotomy incision was made. Twelve biopsies were done with the vacuum assisted 9 gauge Eviva needle. A top hat marker was placed at the site."