19100

Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)

CPT 19100 describes a percutaneous needle core biopsy of the breast performed without the use of imaging guidance. This procedure is specifically designed for evaluating palpable breast masses that can be clearly identified and stabilized by the physician through physical examination. Unlike a fine needle aspiration (FNA), which typically aspirates individual cells or fluid using a small-gauge needle, a core biopsy involves the use of a larger, specialized hollow needle (often 11 to 14 gauge) to extract solid cylinders of tissue. These tissue cores preserve the histological architecture of the suspicious area, allowing pathologists to distinguish between invasive and non-invasive diseases and to identify specific histological features or biomarkers. The procedure begins with the patient in a supine or slightly oblique position. The physician identifies the target lesion via palpation. The skin is cleansed with an antiseptic agent, and a local anesthetic is injected to numb the skin and the underlying breast tissue. The physician makes a small puncture or tiny nick in the skin, then advances the core biopsy needle into the palpable mass. Once the needle is correctly positioned within the lesion, a spring-loaded or vacuum-assisted mechanism is triggered to capture the tissue sample. Multiple passes are often performed to obtain several cores, ensuring a representative sample of the mass. After the samples are retrieved, manual pressure is applied to the site for several minutes to prevent hematoma formation, followed by the application of a sterile dressing. Because this code is designated as a 'separate procedure,' it should only be billed when it is not an integral part of another larger procedure performed on the same breast.

Clinical Indications

  • Presence of a palpable breast mass or lump
  • Evaluation of a dominant breast nodule found during a clinical breast exam
  • Histological confirmation of a suspicious lesion previously identified as stable
  • Differentiating between benign fibroadenomas and malignant tumors in palpable areas
  • Patient preference for core biopsy over fine needle aspiration for palpable lesions
  • Assessment of palpable areas of architectural distortion or thickening

Procedure Steps

  1. Verify patient identity and obtain informed consent.
  2. Position the patient (usually supine) to optimize access to the palpable mass.
  3. Perform a clinical breast exam to re-confirm the exact location and mobility of the mass.
  4. Prep the breast skin with an antiseptic solution (e.g., chlorhexidine or betadine).
  5. Infiltrate the skin and subcutaneous tissue with a local anesthetic, such as 1% lidocaine.
  6. Stabilize the mass between the fingers of one hand.
  7. Insert the core biopsy needle through the skin and advance it to the edge of the mass.
  8. Trigger the biopsy device to cut and capture a tissue core from the lesion.
  9. Remove the needle and retrieve the specimen; repeat the process for multiple samples as clinically indicated.
  10. Place the specimens in a preservative (e.g., formalin) for transport to pathology.
  11. Apply firm manual pressure to the biopsy site to ensure hemostasis.
  12. Apply a sterile adhesive bandage or dressing to the puncture site.

Coding Guidelines

  • Do not use 19100 if imaging guidance (ultrasound, fluoroscopy, stereotactic, or MRI) is used; refer to codes 19081-19086 instead.
  • CPT 19100 is a 'separate procedure' and should not be reported when it is an integral component of another procedure performed on the same breast.
  • For fine needle aspiration of the breast, refer to CPT codes 10004-10021.
  • If a biopsy is performed on both breasts, append modifier 50 (Bilateral Procedure).
  • Use modifiers LT (Left side) and RT (Right side) to specify which breast was biopsied.
  • Code 19100 is used per lesion; if multiple palpable lesions are biopsied in the same breast without imaging, check payer-specific rules regarding multiple units or modifier 51.
  • This code does not include the placement of a localization clip; however, 19100 is rarely used in conjunction with clips as clips usually require imaging for placement.

Associated ICD-10 Codes