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tci Outpatient Facility Coding Alert - 2015 Issue 3

Reader Question: Grab That Extra Reimbursement for a Breast Biopsy in a Non-Facility Setting

Question: Can we report the technical component of breast biopsy services when we are submitting code 19083?  New Jersey Subscriber Answer: Code 19083 (Biopsy, breast, with placement of breast localization device[s] [e.g., clip, metallic pellet], when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance) does not divide into professional and technical components as it is a “physician services code” on the MPFS (Medicare Physician Fee Schedule).  The payment rate differs based on whether the physician reports the code for a facility or non-facility setting. When you’re reporting...

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