Overview of CPT Code 19000:Breast Biopsy, Needle

Overview of CPT Code 19000:Breast Biopsy, Needle

CPT Code 19000 refers to a needle biopsy of the breast, a minimally invasive procedure used to obtain tissue samples from suspicious breast lesions for diagnostic purposes.

When CPT Code 19000 is Used?

This procedure is indicated in various clinical scenarios.

• Presence of a palpable breast mass or lump.
• Abnormal findings on a mammogram or breast ultrasound.
• Monitoring of known breast lesions for changes.
• Evaluation of breast tissue in patients with a family history of breast cancer.

Symptoms Indicating This Procedure

Patients may report several symptoms that warrant a breast biopsy.

• A lump or mass in the breast.
• Changes in breast shape or size.
• Nipple discharge that is bloody or clear.
• Skin changes over the breast, such as dimpling or puckering.

Causes and Risk Factors

Several factors can contribute to the need for a breast biopsy.

• Family history of breast cancer.
• Genetic mutations such as BRCA1 or BRCA2.
• Previous breast cancer diagnosis.
• Age, with increased risk in women over 50.

Diagnostic Tests Before Procedure

Prior to the biopsy, several diagnostic tests may be performed.

• Mammography to identify suspicious areas.
• Breast ultrasound to assess the characteristics of a mass.
• MRI of the breast for detailed imaging.
• Fine needle aspiration cytology for preliminary evaluation.

Procedure Description

The needle biopsy procedure involves several key steps.

• Patient is positioned comfortably, usually lying on their back.
• The area of the breast is cleaned and sterilized.
• Local anesthesia is administered to numb the area.
• A thin needle is inserted into the breast to obtain tissue samples.
• Multiple samples may be taken to ensure adequate tissue for diagnosis.
• The needle is removed, and pressure is applied to minimize bleeding.

Preparation for the Procedure

Patients should follow specific guidelines before the biopsy.

• Inform the doctor of any medications being taken, especially blood thinners.
• Avoid aspirin or anti-inflammatory medications for a few days prior.
• Wear comfortable clothing and avoid wearing deodorant on the day of the procedure.
• Arrange for someone to drive you home if sedation is used.

Recovery and Aftercare

Post-procedure care is essential for recovery.

• Rest for the remainder of the day after the procedure.
• Apply ice packs to reduce swelling and discomfort.
• Keep the biopsy site clean and dry; follow specific wound care instructions.
• Over-the-counter pain relievers may be used as needed.

Possible Complications

While generally safe, there are potential risks associated with the procedure.

• Bleeding at the biopsy site.
• Infection at the site of the biopsy.
• Hematoma formation (a collection of blood outside of blood vessels).
• Discomfort or pain in the breast area.

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Post-Procedure Follow-Up

Follow-up care is important to monitor recovery and results.

• Schedule a follow-up appointment within a week to discuss results.
• Monitor the biopsy site for signs of infection or unusual changes.
• Follow up with imaging studies if recommended by the physician.

Alternative Treatments

There are non-surgical options for managing breast concerns.

• Regular monitoring with imaging for benign lesions.
• Medications for hormonal therapy in certain breast conditions.
• Lifestyle changes, including diet and exercise, to reduce risk.

Home Care Tips

Patients can take simple steps to aid recovery at home.

• Avoid strenuous activities for a few days post-procedure.
• Keep the biopsy site clean and dry.
• Monitor for any signs of infection, such as increased redness or swelling.
• Take prescribed medications as directed.

Patient Education & Prevention

Education is key to prevention and early detection.

• Regular breast self-exams to detect changes early.
• Annual mammograms as recommended by healthcare providers.
• Discuss family history and risk factors with a healthcare provider.
• Maintain a healthy lifestyle to reduce breast cancer risk.

Billing and Coding Information

CPT Code: 19000

Category: Surgical Procedures

Common Modifiers:

• 50 (bilateral procedure)
• RT (right side)
• LT (left side)

Average Cost and Insurance Coverage

Costs can vary based on location and insurance.

• Average cost ranges from $1,000 to $3,000.
• Most insurance plans cover the procedure if deemed medically necessary.
• Patients should verify coverage with their insurance provider.

Related CPT Codes

• 19100 - 'Excision of breast lesion'
• 19101 - Biopsy of breast, percutaneous, needle
• 19102 - Excision of Breast Lesion
• 19103 - Excision of breast lesion, malignant

References and Sources

• Breast Biopsy Overview
• Understanding Breast Biopsy
• Breast Biopsy Procedure