Radiology

Radiology Question for the Week of July 27, 2020

Radiology Compliance Question of the Week

Question:

What if there is a cyst in each breast? How is this coded?

Answer:

Providers should check for payer-specific guidelines. Traditionally this would have been coded 19000-50 or 19000-RT and 19000-LT. However, due to a bilateral indicator of 0 in the Medicare Physician Fee Schedule, for Medicare patients, aspiration of cysts in each breast would be coded 19000 x 2. It has an MUE of 2 (MAI – 3; Date of Service Edit: Clinical). Some payers may require 19000 and 19001 even when the cysts are in separate breasts.