Overview of CPT Code 19215: Breast Biopsy, Needle Localization

Overview of CPT Code 19215: Breast Biopsy, Needle Localization

CPT Code 19215 refers to a procedure where a needle is used to localize a breast lesion for biopsy. This technique is often employed when a breast abnormality is detected through imaging but cannot be felt during a physical examination.

When CPT Code 19215 is Used?

This procedure is indicated in various clinical scenarios.

• Presence of a suspicious breast mass detected on mammography or ultrasound.
• Need for tissue diagnosis of a non-palpable breast lesion.
• Follow-up of abnormal imaging findings that require histological evaluation.

Symptoms Indicating This Procedure

Patients may report several symptoms or findings that lead to this procedure.

• Abnormal mammogram results.
• Breast pain or discomfort.
• Palpable lump or mass in the breast.
• Changes in breast shape or size.

Causes and Risk Factors

Several factors may contribute to the need for a needle localization biopsy.

• Family history of breast cancer.
• Personal history of breast abnormalities.
• Age, particularly women over 40.
• Genetic mutations such as BRCA1 or BRCA2.

Diagnostic Tests Before Procedure

Prior to the procedure, certain tests are typically performed.

• Mammography to identify the location of the lesion.
• Ultrasound for further evaluation of the breast tissue.
• MRI if additional imaging is needed.

Procedure Description

The procedure involves several key steps.

• Patient is positioned comfortably, usually lying on their back.
• Local anesthesia is administered to numb the area.
• Imaging guidance (ultrasound or mammography) is used to locate the lesion.
• A thin needle is inserted into the breast to place a localization wire.
• The wire marks the area for biopsy, and a small incision is made.
• Tissue samples are taken for pathological examination.

Preparation for the Procedure

Patients should follow specific guidelines before the procedure.

• Avoid blood thinners for several days prior to the procedure.
• Inform the doctor of any allergies, especially to anesthesia.
• Wear comfortable clothing and avoid wearing deodorant or lotions on the day of the procedure.

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.
• Follow up with the healthcare provider for results and further instructions.

Possible Complications

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

• Infection at the biopsy site.
• Bleeding or hematoma formation.
• Discomfort or pain at the site.
• Allergic reaction to anesthesia.

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Post-Procedure Follow-Up

Monitoring after the procedure is crucial.

• Schedule a follow-up appointment within a week to discuss biopsy results.
• Monitor for any signs of infection or unusual symptoms.
• Regular breast examinations as advised by the healthcare provider.

Alternative Treatments

There are non-surgical options available for managing breast abnormalities.

• Regular monitoring with imaging if the lesion is benign.
• Medications for pain management.
• Hormonal therapy for certain types of breast conditions.

Home Care Tips

Patients can take steps to aid their recovery at home.

• Keep the biopsy site clean and dry.
• Avoid strenuous activities for a few days.
• Take prescribed pain medications as needed.

Patient Education & Prevention

Education is key to prevention and early detection.

• Regular breast self-exams and clinical exams.
• Annual mammograms as recommended based on age and risk factors.
• Healthy lifestyle choices to reduce breast cancer risk.

Billing and Coding Information

CPT Code: 19215

Category: Surgical Procedures

Common Modifiers:

• 50 (bilateral procedure)
• LT (left side)
• RT (right 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.
• Check with your insurance provider for specific coverage details.

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

• American College of Radiology
• National Cancer Institute
• Mayo Clinic