Summary & Overview
CPT 19126: Excision of Additional Marked Breast Lesion
CPT code 19126 denotes the surgical removal of an additional breast lesion that was preoperatively localized with a radiological marker and excised through an open incision after an initial lesion from the same breast has been removed. This code captures an important intraoperative scenario in breast-conserving surgery where multiple lesions are targeted in a single operative session. Accurate reporting affects surgical case documentation, facility billing, and surgical quality measurement across the country. Key payers considered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context for using CPT code 19126, common sites of service, and how the code fits within breast surgery workflows. The publication outlines benchmarks and coding conventions relevant to this service line, explains typical payer coverage considerations at a national level, and summarizes implications for facility and professional billing. Data not available in the input will be noted where applicable. The content is intended to support coding accuracy, administrative clarity, and alignment between clinical documentation and billing practices for additional marked-lesion excisions in breast surgery.
Billing Code Overview
CPT code 19126 describes the surgical excision of an additional breast lesion that was previously localized with a preoperative radiological marker, performed through an open incision after an initial lesion from the same breast has already been excised. This code represents an additional targeted excisional procedure on the same breast when a separate, marked lesion is removed during the same operative session.
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Service type: Surgical excision of an additional marked breast lesion
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Typical site of service: Hospital outpatient surgical suite or ambulatory surgical center (breast surgery setting)
Clinical & Coding Specifications
Clinical Context
A patient with a suspicious breast lesion previously localized preoperatively with a radiological marker (wire or seed) undergoes surgical excision of that primary lesion. During the same operative session the surgeon identifies an additional radiographically marked lesion in the same breast and performs a second open excision through a separate incision or an extension of the original incision to remove the additional lesion. Typical patients are adult females evaluated for imaging abnormalities such as a new mass, calcifications, or biopsy-proven high-risk lesions who have had preoperative localization. The workflow includes preoperative imaging and localization by radiology, intraoperative specimen radiography as needed to confirm removal of the marker and lesion, pathological submission of separate specimens with labels identifying laterality and specimen sequence, and operative note documentation describing the presence of the additional localized lesion, the technique used to excise it, and confirmation that the preoperative radiologic marker was removed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When procedure performed on the left breast |
RT | Right side | When procedure performed on the right breast |
50 | Bilateral procedure | When both breasts are operated on during same session (if applicable) |
59 | Distinct procedural service | To indicate a separate, distinct excision when reporting multiple procedures that might be bundled |
76 | Repeat procedure by same physician | When the excision is repeated by the same surgeon later the same day (note: 76 not in input list; therefore not used) |
51 | Multiple procedures | When additional procedures are performed in the same operative session and payer rules require this modifier |
52 | Reduced services | If the excision was started but deliberately not completed or scope was reduced |
78 | Return to operating room for a related procedure during the postoperative period | For unplanned return to OR related to the initial breast procedure |
22 | Increased procedural services | When work or complexity substantially exceeds typical for this procedure and documentation supports it |
26 | Professional component | When billing only the professional component for services that have distinct technical/professional components (rare for excision codes) |
59 | Distinct procedural service | When reporting an additional excision that is separate from the initial lesion removal (already listed above for emphasis) |
XC | Separate encounter (part of the XS family) | Not in input list; not used |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N60.11 | Hypertrophy of left breast | May prompt imaging and localization if a focal lesion is identified |
N60.12 | Hypertrophy of right breast | See above for right-sided relevance |
N63 | Unspecified lump in breast | Common clinical indication for localization and excision of one or more lesions |
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Imaging abnormalities that lead to localization and surgical excision |
D05.10 | Lobular carcinoma in situ of breast, unspecified breast | High-risk lesion that may be localized and excised as part of diagnostic/therapeutic management |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19125 | Excision of breast lesion identified by preoperative placement of radiological marker, open; first lesion | Performed immediately before or alongside 19126 when removing the first localized lesion from the same breast |
19301 | Mastectomy, partial (partial mastectomy, lumpectomy) | May be used if the surgical plan requires a wider excision or partial mastectomy encompassing lesion(s) beyond localized excisions |
19290 | Localization procedure for lesion(s) of breast, placement of localization device (e.g., wire, seed) | Performed preoperatively by radiology to localize lesions that are later excised with 19125/19126 |
76085 | Mammography, previous radiographic comparison and preoperative localization, breast, each lesion, image-guided | Imaging support during localization and intraoperative specimen radiograph correlation |
88305 | Surgical pathology, gross and microscopic examination, level IV | Common pathology code for tissue sections of excised breast lesions submitted after 19126 |