19081

Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance

The CPT code 19081 represents a minimally invasive percutaneous breast biopsy of a single, initial lesion using stereotactic (X-ray) guidance. This procedure is crucial for the definitive diagnosis of suspicious breast lesions, calcifications, or architectural distortions identified on screening or diagnostic mammography. It includes several key procedural components bundled into a single comprehensive code: the core needle or vacuum-assisted biopsy itself, the mandatory stereotactic imaging guidance used to accurately target the lesion, the placement of a breast localization device (such as a metallic clip or pellet) to mark the biopsy site for future reference or surgical intervention, and the radiographic imaging of the obtained biopsy specimen to confirm that the targeted microcalcifications or tissues have been successfully harvested. The procedure begins with the patient positioned typically in a prone position on a specialized stereotactic biopsy table, where the breast is compressed and stabilized. High-resolution digital imaging at different angles (stereo pairs) calculates the precise three-dimensional coordinates of the target lesion. Local anesthetic is administered to ensure patient comfort throughout the intervention. A small skin incision is made, and a specialized biopsy probe is advanced to the calculated coordinates. Tissue samples are acquired, often using a vacuum-assisted mechanism which pulls tissue into the sampling chamber for sequential cutting and retrieval. A specimen radiograph is then immediately performed to verify the presence of the suspicious target (e.g., microcalcifications) within the retrieved cores. Once confirmed, a radiopaque tissue marker is deployed through the probe into the biopsy cavity. The probe is removed, and hemostasis is achieved with manual pressure, followed by the application of a sterile dressing. Code 19081 specifically denotes the first lesion biopsied using stereotactic guidance. If additional lesions are biopsied during the same session using the same imaging modality, the add-on code 19082 must be used for each subsequent lesion. This code inherently bundles the biopsy, image guidance, marker placement, and specimen imaging; therefore, these services should not be reported separately when performed on the same lesion. Utilizing stereotactic guidance allows for sub-millimeter precision, making it the modality of choice for lesions that are well visualized on mammography but occult on ultrasound or clinical exam.

Clinical Indications

  • Suspicious microcalcifications identified on a screening or diagnostic mammogram (BI-RADS 4 or 5)
  • Solid masses or architectural distortions visualized on mammography but poorly seen or occult on ultrasound
  • Follow-up of a previously identified probably benign finding (BI-RADS 3) that has demonstrated interval progression or change
  • Spiculated lesions suspicious for malignancy requiring tissue diagnosis prior to surgical planning
  • Focal asymmetric densities requiring histopathologic correlation prior to definitive treatment

Procedure Steps

  1. Position the patient prone on a dedicated stereotactic biopsy table, allowing the affected breast to fall through the aperture.
  2. Compress and immobilize the breast to ensure precision.
  3. Acquire scout and stereotactic pair images (typically at +15 and -15 degrees) to target the lesion and calculate depth and spatial coordinates.
  4. Administer local anesthesia (e.g., lidocaine) to the skin and deeper breast tissue along the anticipated biopsy tract.
  5. Create a small dermatotomy (skin nick) to allow passage of the biopsy needle or vacuum-assisted probe.
  6. Advance the biopsy device to the targeted coordinates under stereotactic tracking.
  7. Perform pre-fire and post-fire stereotactic imaging to confirm accurate needle placement relative to the lesion.
  8. Retrieve multiple tissue core samples using a vacuum-assisted or core needle mechanism.
  9. Perform radiographic imaging of the biopsy specimen to confirm the capture of targeted findings, such as microcalcifications.
  10. Deploy a localization device (e.g., metallic clip) into the biopsy cavity through the probe.
  11. Remove the biopsy device, apply manual pressure to the site to achieve hemostasis, and apply a sterile dressing and steri-strips.
  12. Perform a post-procedure mammogram (typically CC and lateral views) to document the final position of the localization clip.

Coding Guidelines

  • Report 19081 for the first lesion biopsied using stereotactic guidance.
  • Do not report 19081 in conjunction with 77012 (CT guidance), 76942 (US guidance), or 77021 (MR guidance) for the same lesion, as image guidance is inherently included.
  • The placement of a localization device (clip, pellet) and the imaging of the biopsy specimen are included in this code and should not be reported separately.
  • If an additional lesion is biopsied using stereotactic guidance during the same encounter, report the add-on code 19082 for each additional lesion.
  • If a separate lesion is biopsied using a different imaging modality (e.g., ultrasound), report the appropriate primary code for that modality (e.g., 19083) and append modifier 59 or XS to indicate a distinct procedural service.
  • Post-procedure mammography performed to confirm clip placement (e.g., 77065) is typically separately reportable depending on payer policy, though some payers consider it bundled.
  • Do not report 19081 for a biopsy performed without any imaging guidance; use 19100 instead.

Associated ICD-10 Codes