Overview of CPT Code 19281: Breast Biopsy, Needle, Percutaneous

Overview of CPT Code 19281: Breast Biopsy, Needle, Percutaneous

CPT Code 19281 refers to a percutaneous needle biopsy of the breast, a minimally invasive procedure used to obtain tissue samples for diagnostic evaluation of breast abnormalities.

When CPT Code 19281 is Used?

This procedure is indicated in various clinical scenarios.

• Suspicious breast mass detected on imaging studies.
• Abnormal findings on a clinical breast exam.
• Follow-up of previously identified 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 warrant a breast biopsy.

• Palpable 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 may contribute to the need for a breast biopsy.

• Family history of breast cancer.
• Genetic mutations such as BRCA1 or BRCA2.
• Previous breast biopsies with atypical results.
• Age, with increased risk in women over 40.

Diagnostic Tests Before Procedure

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

• Mammography to identify abnormalities.
• Ultrasound to evaluate breast masses.
• MRI for detailed imaging of breast tissue.
• Fine needle aspiration cytology for preliminary assessment.

Procedure Description

The 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 tissue to obtain a sample.
• 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.

• Avoid blood thinners for several days prior to the procedure.
• Inform the physician of any allergies, especially to anesthetics.
• Wear comfortable clothing and avoid wearing deodorant or lotions on the day of the procedure.
• Arrange for transportation 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 localized collection of blood).
• 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 one week to discuss biopsy results.
• Monitor the biopsy site for signs of infection or excessive swelling.
• Report any unusual symptoms, such as fever or increased pain, to the physician.

Alternative Treatments

There are non-surgical options for managing breast abnormalities.

• Regular monitoring with imaging studies 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 steps to aid their recovery at home.

• Keep the biopsy site clean and dry.
• Avoid strenuous activities for a few days.
• Wear a supportive bra to minimize discomfort.
• Stay hydrated and maintain a balanced diet.

Patient Education & Prevention

Education is key to preventing breast health issues.

• Perform regular breast self-exams to detect changes early.
• Schedule routine mammograms as recommended by your physician.
• Discuss family history and risk factors with your healthcare provider.
• Adopt a healthy lifestyle to reduce overall cancer risk.

Billing and Coding Information

CPT Code: 19281

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

• 19282 - Placement of breast tissue expander
• 19100 - 'Excision of breast lesion'
• 19101 - Biopsy of breast, percutaneous, needle
• 19120 - Excision of Breast Lesion
• 19125 - Excision of breast lesion

References and Sources

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