Ask Dr. Z

We have cases where the patient is scheduled for an MRI-guided breast biopsy. The MRI guidance is performed, and a lesion could not be found, so the biopsy is canceled. Report example: "After discussion of potential risks, alternatives, and benefits of the procedure, the patient gave verbal and written informed consent for the procedure. She was placed prone on the table, and her breast was placed in the compression grid. Initial noncontrast fat suppressed T1 images were obtained. This demonstrates satisfactory positioning. Subsequently, three sets of postcontrast fat suppressed T1 images were obtained. These do not demonstrate the finding of interest seen on the initial mammogram. On today's exam, there is just scattered normal background parenchymal enhancement. It is felt that the initial finding represents part of this normal background parenchymal enhancement. Since the finding was not reproduced, no biopsy could be performed. The procedure was then terminated. Findings were discussed in detail with the patient at the time of interpretation. The recommendation is for six-month follow up breast MRI to evaluate stability. There are no suspicious areas of enhancement to biopsy on today's exam. Impression: Previously identified 8 mm enhancing mass left breast is not reproduced on the current exam. It is felt that this may represented background parenchymal enhancement. As it is not reproduced, no biopsy is performed."

Per Coding Clinic for HCPCS, 2nd quarter 2008, it has an example for a canceled stereotactic breast biopsy. "Q. A patient was scheduled for stereotactic breast biopsy of the left breast. Stereotactic images were performed; however, the lesion to be biopsied was not visualized. Anesthesia was not administered and the biopsy was not performed. How should this encounter be reported? A. It would be appropriate to report the CPT codes 19102 with modifier -LT, and 77031 for stereotactic localization, for the procedures performed. Although the breast lesion was not visualized, the biopsy was planned; therefore, CPT code 19102 should be reported with modifier -73 only if taken to the treatment room."

Does a canceled MRI-guided breast biopsy follow the same rules as a canceled stereotactic biopsy? Should we only bill for a breast MRI (77058) on both the FAC and PRO side, or should we bill codes 19102-73 and 77031 on the FAC side and only 77031 on the PRO side? Also, is the guideline for the canceled stereotactic biopsy okay to follow, or has that changed? Since we bill for both FAC and PRO, please address both.