CPT® Code 19284

Add-On Code

Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)

The CPT® Code 19284 refers to the procedure of placing breast localization devices, which are essential tools used to mark the precise location of lesions in the breast prior to surgical interventions such as biopsies or lumpectomies. These devices can include various forms such as clips, metallic pellets, wires or needles, and radioactive seeds. The primary purpose of this procedure is to ensure that the physician can accurately identify the lesion's site during surgery, thereby enhancing the effectiveness of the treatment. The localization process involves marking the area of concern on the skin and utilizing stereotactic guidance, a technique that employs 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 that 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 to further refine the lesion's location. Geometric calculations are then applied to ascertain the lesion's precise three-dimensional coordinates. Once the localization is confirmed, a needle is advanced into the lesion, and imaging is conducted to verify the needle's placement. For wire localization, a hooked wire is inserted into the lesion at a perpendicular angle, remaining anchored within the mass as the needle is withdrawn, with a portion of the wire extending outside the skin.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. It is important to note that CPT® Code 19284 is used for each additional lesion, while CPT® Code 19283 is designated for the placement of the localization device in the first lesion.