CPT® Code 19283

Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance

The procedure described by CPT® Code 19283 involves the placement of a breast localization device, which can include various types such as clips, metallic pellets, wires/needles, or radioactive seeds. This procedure is crucial for accurately identifying the precise location of a lesion in the breast prior to conducting a biopsy or lumpectomy. The localization device serves as a marker, allowing the physician to target the area of concern effectively. To facilitate this process, stereotactic guidance is employed, which utilizes a fixed coordinate system to pinpoint the lesion's unique location within the breast. This is achieved by defining the lesion's position in three-dimensional space using specific x, y, and z coordinates relative to a reference point. During the procedure, the breast is positioned between a compression plate and a support structure to stabilize the lesion. The thickness of the breast under compression is a critical factor, as it determines the depth of the lesion. An initial imaging study is performed at a perpendicular angle to the compression plate, which helps to center the lesion within the biopsy window. Subsequent images are captured at various angles, allowing for precise geometric calculations to ascertain the lesion's location in three dimensions. Once the lesion's position is confirmed, a needle is advanced into the lesion, and imaging is conducted to verify the needle's placement within the mass. For wire localization, a hooked wire is inserted at a perpendicular angle using a needle, remaining anchored in the lesion as the needle is withdrawn, with a portion of the wire extending outside the skin. Alternatively, a plastic stylet equipped with a localization device, such as a clip, metallic pellet, or radioactive seed, is inserted through the biopsy needle and guided to the lesion site using stereotactic techniques. Upon reaching the target, the localization device is released, and both the stylet and needle are removed. This procedure is specifically coded as 19283 for the first lesion, with additional lesions coded separately under 19284.