February 28, 2016

Q and A

What CPT code should be used for a computed tomography (CT)-guided breast wire localization. Should code 10035 Placement of soft-tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion or code 19499 Unlisted procedure, breast be reported?

For CT-guided placement of breast localization devices, it is recommended that providers use CPT code 10035 (Placement of soft-tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion). The CPT 2016 introductory note prior to 10035 states that Soft-tissue marker placement with imaging guidance is reported with 10035 and 10036. If a more specific site descriptor than soft-tissue is applicable (eg, breast,) use the site-specific codes for marker placement at that site. Report 10035 and 10036 only once per target, regardless of how many markers (eg, clips, wires, pellets, radioactive seeds) are used to mark that target.

Since there is no site-specific breast code for wire localization including CT guidance, the implied option is to use 10035.

Code 10035 and add-on code 10036 bundle in the radiological guidance, therefore, it is inappropriate to report CPT® codes 76942, 77002, 77012, or 77021 in conjunction with codes 10035 and 10036.

Soft-tissue marker placement is typically performed with some type of imaging guidance - most commonly ultrasound, but fluoroscopy, computed tomography, or magnetic resonance imaging may also be used.