Overview of CPT Code 19001: Breast Biopsy, Needle, Open
CPT Code 19001 refers to an open needle biopsy of the breast, a procedure used to obtain tissue samples for diagnostic evaluation of breast abnormalities.
When CPT Code 19001 is Used?
This procedure is indicated in various clinical scenarios.
- Presence of a palpable breast mass or lump.
- Abnormal findings on a mammogram.
- Suspicious breast lesions identified during imaging studies.
- Evaluation of breast tissue for cancer or other diseases.
Symptoms Indicating This Procedure
Patients may report several symptoms that warrant this biopsy.
- A noticeable 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 redness.
Causes and Risk Factors
Several factors may contribute to the need for a breast biopsy.
- Family history of breast cancer.
- Personal history of breast disease.
- Age, particularly women over 40.
- Genetic mutations such as BRCA1 or BRCA2.
Diagnostic Tests Before Procedure
Prior to the biopsy, certain tests may be conducted.
- Mammography to identify abnormalities.
- Ultrasound to assess the characteristics of the lump.
- MRI for detailed imaging of breast tissue.
- Fine needle aspiration (FNA) for preliminary evaluation.
Procedure Description
The procedure involves several key steps.
- Patient is positioned comfortably, and the breast area is cleaned.
- Local anesthesia is administered to numb the area.
- A small incision is made to access the breast tissue.
- A needle is inserted to obtain tissue samples from the suspicious area.
- The incision is closed with sutures or adhesive strips.
Preparation for the Procedure
Patients should follow specific guidelines before the biopsy.
- Avoid blood thinners or aspirin for several days prior.
- Inform the doctor of any allergies or medications.
- Wear comfortable clothing and arrange for transportation post-procedure.
- Follow any fasting instructions if sedation is planned.
Recovery and Aftercare
Post-procedure care is essential for healing.
- Rest for the remainder of the day after the procedure.
- Keep the biopsy site clean and dry.
- Apply ice packs to reduce swelling as needed.
- Follow up with the doctor for suture removal if necessary.
Possible Complications
While generally safe, some risks are associated with the procedure.
- Infection at the biopsy site.
- Bleeding or hematoma formation.
- Pain or discomfort at the site.
- Scarring or changes in breast appearance.
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Post-Procedure Follow-Up
Monitoring after the procedure is crucial.
- Schedule a follow-up appointment within a week.
- Discuss biopsy results and further management options.
- Monitor for any signs of complications.
Alternative Treatments
There are non-surgical options for managing breast abnormalities.
- Regular monitoring with imaging studies.
- Medications for hormonal therapy if indicated.
- Lifestyle changes to reduce risk factors.
Home Care Tips
Patients can take steps to aid recovery at home.
- Avoid strenuous activities for a few days.
- Take prescribed pain medications as directed.
- Keep the biopsy site clean and dry.
- Monitor for any unusual symptoms and report them to the doctor.
Patient Education & Prevention
Education is key to prevention and early detection.
- Perform regular breast self-exams.
- Schedule routine mammograms as recommended.
- Discuss family history with healthcare providers.
- Adopt a healthy lifestyle to reduce breast cancer risk.
Billing and Coding Information
CPT Code: 19001
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.
- Out-of-pocket costs depend on the patient's insurance plan.
Related CPT Codes
- 19000 - Breast Biopsy, Needle
- 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
Frequently Asked Questions (FAQs)
What is a breast biopsy?
A breast biopsy is a procedure to remove tissue from the breast for testing.
Is the procedure painful?
Local anesthesia is used to minimize discomfort during the procedure.
How long does recovery take?
Most patients can return to normal activities within a few days.
When will I get my results?
Results are typically available within a week after the biopsy.
Are there risks involved?
As with any procedure, there are risks such as infection or bleeding.
