Fine Needle Aspiration & Core Biopsy

Part 2 of 4

One pair of codes for each kind of imaging

FNA codes are built around the imaging guidance. Each imaging type has two codes: one for the first lesion and an add-on for each additional lesion.

• FNA with no imaging (the doctor feels the lump): 10021, then +10004 for each additional lesion.
• FNA with ultrasound: 10005, then +10006.
• FNA with fluoroscopy: 10007, then +10008.
• FNA with CT: 10009, then +10010.
• FNA with MR: 10011, then +10012.

Because the guidance is part of the FNA code, never add 76942, 77002, 77012 or 77021 for the FNA itself. Those separate guidance codes belong to the core biopsy (see the table in the first part).

Part 3 of 4

The five scenarios

The doctor can use both techniques in one session: both on the same lesion, or FNA on one lesion and a core biopsy on another. The CPT guidelines before the FNA codes explain how to report each combination. The deciding question is same lesion or different lesions.

1. Two lesions, FNA with ultrasound on both. Two lumps in the right breast, each aspirated under ultrasound: 10005 + 10006. One imaging type, so the first lesion gets the primary code and the second gets its own add-on.
2. Two lesions, FNA with ultrasound, then FNA with fluoroscopy. A neck lymph node by ultrasound and a lung nodule by fluoroscopy: 10005 + 10007. The imaging differs, so each lesion gets the first-lesion code for its own imaging type.
3. One lesion, FNA and core biopsy, both with ultrasound. The doctor aspirates a thyroid nodule, then takes a core from the same nodule: 10005 + 60100. No 76942: there was one ultrasound on one lesion, and it's already paid inside 10005.
4. Lesion 1 FNA with ultrasound, lesion 2 core biopsy with ultrasound. A right armpit lymph node is aspirated, then a liver mass has a core biopsy: 10005 + 47000 + 76942-59. The liver's ultrasound was for a different lesion, so it's reported, with 59 (or XS, separate structure, for Medicare).
5. Lesion 1 FNA with ultrasound, lesion 2 core biopsy with fluoroscopy. A left breast lump by ultrasound, then a hip bone (ilium) biopsy by fluoroscopy: 10005 + 20220 + 77002-59. The ilium is a superficial bone (20220; a deep bone such as the femur is 20225), and +77002 is an add-on, again with 59 or XS.

Three and four lesions

The same rules stretch to any number of lesions. Go lesion by lesion:

• FNA: one pair per imaging type. The first lesion with that imaging gets the first-lesion code, every later one gets that pair's add-on.
• Core biopsy: one organ code per lesion. A second core of the same organ repeats the code with 59 or XS.
• Core guidance: each guidance code once for the session, with 59 or XS because an FNA was also done.

1. FNA ultrasound, FNA fluoroscopy, FNA fluoroscopy: 10005 + 10007 + 10008. Ultrasound has one lesion, so just 10005. Fluoroscopy has two, so 10007 then its add-on +10008.
2. FNA ultrasound × 2, FNA fluoroscopy × 2: 10005 + 10006 + 10007 + 10008. Two pairs, one per imaging type.
3. FNA fluoroscopy on four lesions: 10007 + 10008 + 10008-59 + 10008-59 (or XS). Each lesion after the first gets +10008; the repeated lines carry 59 or XS to show they're separate lesions.
4. FNA ultrasound, then two liver cores by ultrasound: 10005 + 47000 + 47000-59 + 76942-59 (or XS). Two liver lesions, two 47000s. Both cores used ultrasound, so 76942 is reported only once.
5. FNA ultrasound, liver core by ultrasound, liver core by fluoroscopy: 10005 + 47000 + 47000-59 + 76942-59 + 77002-59 (or XS). Each core used a different imaging type, so both guidance codes are reported.

Part 4 of 4

Practice cases