Overview of CPT Code 19255: Percutaneous Breast Biopsy
CPT Code 19255 refers to a percutaneous breast biopsy, a minimally invasive procedure used to obtain tissue samples from a suspicious area in the breast for diagnostic purposes. This procedure is typically guided by imaging techniques such as ultrasound or mammography.
When CPT Code 19255 is Used?
This procedure is indicated in various clinical scenarios.
- Presence of a palpable breast mass that requires further evaluation.
- Abnormal findings on a mammogram that necessitate tissue sampling.
- Follow-up of previously diagnosed breast lesions.
- Assessment of breast tissue in patients with a family history of breast cancer.
Symptoms Indicating This Procedure
Patients may report several symptoms that lead to the need for a 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 abnormal areas.
- Ultrasound to assess the characteristics of the breast mass.
- MRI for detailed imaging of breast tissue.
- Fine needle aspiration cytology for preliminary evaluation.
Procedure Description
The percutaneous breast biopsy involves several key steps.
- Patient is positioned comfortably, and the breast is exposed.
- Local anesthesia is administered to numb the area.
- Imaging guidance (ultrasound or mammography) is used to locate the target area.
- A small incision is made, and a biopsy needle is inserted to obtain tissue samples.
- Multiple samples may be taken to ensure adequate tissue for diagnosis.
- The incision is closed, and a bandage is applied.
Preparation for the Procedure
Patients should follow specific guidelines before the biopsy.
- Avoid blood thinners or anti-inflammatory medications for several days prior.
- Inform the doctor of any allergies or medical conditions.
- Wear comfortable clothing and avoid wearing deodorant or lotions on the day of the procedure.
- Arrange for someone to drive you home post-procedure 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 incision site.
- 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 crucial for monitoring recovery.
- Schedule a follow-up appointment within a week to discuss biopsy results.
- Monitor the biopsy site for signs of infection or unusual changes.
- Follow up with imaging studies as recommended by the physician.
Alternative Treatments
There are non-surgical options for managing breast abnormalities.
- Regular monitoring with imaging for benign lesions.
- Medications for hormonal therapy in certain breast conditions.
- Lifestyle changes, including diet and exercise, to reduce breast cancer 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 complications, such as increased pain or swelling.
- Stay hydrated and maintain a balanced diet to support healing.
Patient Education & Prevention
Education is key to prevention and early detection.
- Regular breast self-exams to detect changes early.
- Routine mammograms as recommended based on age and risk factors.
- Discuss family history and genetic testing options with a healthcare provider.
Billing and Coding Information
CPT Code: 19255
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.
- Patients should verify coverage details 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
- 19120 - Excision of Breast Lesion
References and Sources
Frequently Asked Questions (FAQs)
Is the percutaneous breast biopsy painful?
Most patients experience minimal discomfort due to local anesthesia.
How long does the procedure take?
The procedure typically takes about 30 minutes.
When will I get my results?
Results are usually available within a week.
Can I drive after the procedure?
If sedation is used, it is recommended to have someone drive you home.
What should I do if I notice bleeding?
Contact your healthcare provider if you experience excessive bleeding.
