The healthcare system uses Current Procedural Terminology (CPT) codes to standardize the description of medical services and procedures, ensuring accurate communication between providers and insurance companies. CPT 19083 is a highly specific code used to report a complex, image-guided procedure involving the removal of breast tissue for diagnostic purposes within breast care.
Decoding CPT 19083
CPT 19083 identifies a percutaneous breast biopsy procedure for the first lesion, performed using ultrasound guidance. This minimally invasive procedure involves using a needle through a small skin incision. The code definition includes the biopsy, the placement of a breast localization device, and imaging of the biopsy specimen, if performed.
Ultrasound guidance uses high-frequency sound waves to create real-time images, allowing the radiologist to precisely navigate the needle to the target lesion. Immediately after tissue removal, a localization device—often a small metallic clip or pellet—is deployed at the biopsy site. This marker is typically made from an inert, biocompatible material.
The placement of this device is considered an integral part of the service described by CPT 19083, encompassing the entire process from tissue removal to site marking. Since the code is designated for the “first lesion,” it establishes the base procedure for a single, distinct area of concern.
The Clinical Purpose of Localization Markers
The primary reason for placing a localization marker is to provide a permanent, visible reference point for the exact location of the biopsied tissue. This is important for non-palpable lesions that cannot be felt by hand. The marker ensures that if the biopsy results require further intervention, such as surgery, the surgeon can accurately target the precise area.
The marker is also important if the patient undergoes neoadjuvant chemotherapy before surgery. Chemotherapy can cause the tumor to shrink significantly, making it difficult to locate for surgical removal. By marking the original tumor bed, the metallic clip allows for precise re-identification and excision of the tissue that contained the malignancy.
For lesions found to be benign, the marker remains to facilitate long-term surveillance. It provides a clear landmark for future mammograms or ultrasounds, allowing the care team to monitor the site for any changes. The presence of the clip aids in correlating findings across different imaging modalities.
Understanding Related CPT Codes and Billing
CPT 19083 is a bundled code reporting a comprehensive service, including the biopsy, imaging guidance, and marker placement. This code is used specifically when the breast biopsy is performed under ultrasound guidance.
The choice of the primary CPT code is determined by the imaging modality used for guidance. For example, CPT 19081 describes the same procedure for the first lesion but uses stereotactic guidance, which relies on specialized mammography. CPT 19085 is used when the biopsy is guided by Magnetic Resonance Imaging (MRI).
When multiple, separate lesions are biopsied in the same breast using the same imaging modality, “add-on” codes report the additional work. CPT 19084 is reported for each additional lesion biopsied using ultrasound guidance. Billing is based on the number of distinct lesions, not the number of tissue samples taken from a single lesion.
If a patient undergoes biopsies on both breasts during the same session, a specific billing modifier, such as modifier 50 for bilateral procedures, may be required depending on the payer’s rules. Accurate reimbursement requires understanding the correct combination of primary codes, add-on codes, and modifiers.
Patient Experience and Post-Procedure Expectations
The placement of the localization marker is performed as a seamless extension of the biopsy procedure, using the same small needle. Patients experience minimal, temporary discomfort associated with the biopsy itself, and the marker placement does not add noticeable pain. The entire process is minimally invasive and performed on an outpatient basis.
Immediately following the procedure, a post-biopsy mammogram is often conducted to confirm the accurate positioning of the marker. Patients are typically instructed to manage minor bruising and swelling with cold compresses and over-the-counter pain relievers. Most individuals can resume normal, light activities within a day.
A common patient concern involves the clip’s permanence and compatibility with future medical procedures. Since the markers are made from inert materials, they are safe for future MRI scans and remain in the breast indefinitely without causing complications. The clips are too small to trigger airport security metal detectors, alleviating travel concerns.