David C. Levin MD, Presenter: Consultant, HealthHelp Board of Directors, Outpatient Imaging Affiliates, LLC

Barbara C. Cavanaugh MD, Abstract Co-Author: Nothing to Disclose

Gordon F. Schwartz MD, Abstract Co-Author: Nothing to Disclose

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Vijay Madan Rao MD, Abstract Co-Author: Nothing to Disclose

A recent paper in the American Journal of Surgery (AJS) reported that surgical breast biopsy is used for 30% of biopsies, an excessive number. Their stated biopsy volume included CPT code 19125 (“excision of breast lesion identified by preoperative placement of radiological marker, open”). However, this code is used for surgical excision both when performed for diagnostic biopsy as well as for excision of lesion diagnosed on percutaneous needle biopsy (NB). Therefore the results reported in the AJS may not accurately reflect the percent of biopsies performed as surgical excision. Our goal is to more accurately assess the use of NB compared with surgical biopsy.

The nationwide Medicare Part B databases for 2004-2009 were used. Trends in use of codes 19100, 19102, and 19103 (NB codes), and 19101 (open biopsy) and the aforementioned 19125 were determined. Medicare’s specialty codes were used to determine who performed the procedures.

Among designated biopsy codes 19100, 19101, 19102, 19103, a total of 173,290 Medicare procedures were done in 2009, of which 169,411 (98%) were NBs. Of these, radiologists performed 123,466 (73%). Their share in 2004 had been 66%. If one includes all 34,186 claims using 19125 as “biopsies”, the 2009 biopsy volume becomes 207,476, of which 82% were NBs. If one instead assumes that half the 19125 claims were intended as excisional biopsies for diagnosis and the other half for excision after NB, the total biopsy volume becomes 190,383, of which 89% were NBs. Between 2004 and 2009, the use of the codes for NB with imaging guidance, 19102 and 19103, increased 12% and 42% respectively. The use of the code for NB without imaging guidance (19100) declined 45%; and the use of 19125 declined 39%.

The previously published statement that 30% of breast biopsies are done surgically is incorrect. Our Medicare data indicate that the true surgical biopsy figure is between 2-18%, probably closer to 11%. Since the recommended rate is 10%, it appears that surgeons and radiologists are collaborating well and that surgical breast biopsy is not being overused. Radiologists predominate in image-guided NB.

not applicable

Levin, D, Cavanaugh, B, Schwartz, G, Parker, L, Rao, V, Percutaneous Needle vs Surgical Breast Biopsy: Previously Stated Allegations of Overutilization of Surgery Are in Error.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004855.html