Reprinted from June 2003 CAP TODAY
Q: Is an oriented needle-localization lumpectomy specimen, which turns
out to be benign, coded as 88305 or 88307?
A: The final diagnosis is not the sole determining factor in assigning
the appropriate CPT code for breast excisions. If the clinical assessment
and mammography findings determine the need to assess adequacy of the
excision (with microscopic evaluation of the margins), and the material
is prepared and evaluated, then it should be coded accordingly. In this
scenario the appropriate code is 88307 Breast, Excision of Lesion,
Requiring Microscopic Evaluation of Surgical Margins.
Q: We often receive mammography films in conjunction with a breast
specimen as a part of our complete surgical pathology consultation. Can
we bill CPT code 76098 for our evaluation of the specimen mammogram?
A: CPT code 76098, Radiological examination, surgical specimen,
can be reported if the films are interpreted as an integral part of the
evaluation. Medical record documentation should reflect the interpretation
as well as the evaluation. Because you did not perform the mammography,
the professional component modifier (-26) should be appended to the CPT
code. It should also be noted that Medicare generally does not pay for
two physicians to read and interpret a film, so you may not receive payment
if the radiologist has submitted a claim for the same service.
Frequently asked questions about CPT are published bimonthly in “Capitol
Scan.” This addition to CAP TODAY is a product of the CAP Economic
The codes and descriptions listed here are from Current Procedural Terminology,
a copyrighted publication of the American Medical Association. To purchase
CPT books, call the AMA at (800) 621-8335.