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Cases , Coding

Mark Gittleman, MD/

Dr. Gittleman's Coding Corner: US guided marker placement in sentinel node

Question:

Needle core biopsy of a 2.6 cm suspicious right breast mass reveals ER-, Her2 + IDC. What CPT code should be used for placement of a marker with US guidance into the suspicious axillary node prior to neoadjuvant systemic treatment?

Answer:

CPT code 10035 (Placement of soft tissue localization device(s) (eg, clip,metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance, first lesion)

For 2017, the reimbursement (Medicare national average)  in the non-facility (private practice) setting is $547 (RVU 15.25 X CF 35.89). For the facility setting (hospital, or hospital-owned practice setting) reimbursement is $92.

 

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