Coding Breast Biopsies 19120 vs 19125 and 19126

Question:

I’m confused as to why 19120, excision of breast mass requires different incisions to bill two excisions, when 19125 and +19126 removing two breast masa with a wire or marker does not require separate incisions.

Answer:

Code 19120 is a primary case and as such includes the exposure ( opening), the excision of the mass and the closure. So, to bill a second 19120, a second exposure and closure must be performed to support a second primary code. With codes 19125 and +19126, the code for the second excision and removal is an add on code. As an add on code, the value is reduced, does not include an exposure and closure, and is only valued for the intraoperative work. Therefore, a separate incision is not required for removal of a second mass via the same incision.

*This response is based on the best information available as of 06/022/23.