We are continuing our series on notable changes for CPT in 2019. Another area of the code manual that received a pretty extensive overhaul involved the codes for FNA biopsies. The acronym FNA stands for “fine needle aspiration.” In this technique, the surgeon typically aspirates fluid for biopsy using a fine gauge needle (he/she will often use a 22 or 25 gauge needle in this procedure). The surgeon then withdraws fluid (e.g., from a cyst) or may withdraw clusters of cells from a solid mass and that specimen is sent to pathology to obtain a diagnosis. The term “biopsy” was added to the FNA codes in 2019 to clarify that these codes should not be reported if the intent of the procedure is simply to drain fluid (there are other codes for fluid drainage in CPT). The intent of these FNA biopsy codes is to report use of a fine gauge needle to withdraw a specimen for purposes of biopsy (i.e., getting a diagnosis from the specimen).
In 2018, we only had two codes available for an FNA biopsy: CPT 10021 for an FNA biopsy without imaging guidance and 10022 for an FNA biopsy with imaging guidance. For CPT 10022 for the FNA biopsy with imaging guidance, you then had to add a second code to represent the exact type of imaging guidance used (77002 for fluoroscopy, 76942 for ultrasound, 77012 for CT guidance, or 77022 for MR guidance).
For 2019, though, we now have combination codes that capture FNA biopsy performed using specific types of imaging guidance (e.g., FNA biopsy with fluoroscopic guidance is all captured with a single code). The codes have also been designed to include primary codes for FNA biopsy of the first lesion and add on codes for each additional lesion where FNA biopsy is performed using the same type of imaging guidance.
Let’s start by looking at all of the new codes and their descriptions:
FNA Biopsy Without Imaging Guidance
10021 -Fine needle aspiration biopsy, without imaging guidance; first lesion
+10004 –Fine needle aspiration biopsy, without imaging guidance; each additional lesion (list separately in addition to code for primary procedure)
FNA Biopsy With Ultrasound Guidance
10005 –Fine needle aspiration biopsy, including ultrasound guidance; first lesion
+10006 –Fine needle aspiration biopsy, including ultrasound guidance;each additional lesion (list separately in addition to code for primary procedure)
FNA Biopsy with Fluoroscopic Guidance
10007 –Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
+10008 –Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion (list separately in addition to code for primary procedure)
FNA Biopsy with CT Guidance
10009 –Fine needle aspiration biopsy, including CT guidance;first lesion
+10010 –Fine needle aspiration biopsy, including CT guidance;each additional lesion (list separately in addition to code for primary procedure)
FNA Biopsy with MR Guidance
10011 –Fine needle aspiration biopsy, including MR guidance;each additional lesion (list separately in addition to code for primary procedure)
+10012 –Fine needle aspiration biopsy, including MR guidance;each additional lesion (list separately in addition to code for primary procedure)
With the creation of these new codes for FNA biopsy, there are a couple of key guidelines to keep in mind:
- You can no longer report imaging guidance codes 77002, 76942, 77012, or 77022 with the FNA biopsy codes to report the imaging guidance used to perform the FNA biopsy itself or a core biopsy on the same lesion during the same encounter. Again the new combination codes already include the work of the FNA biopsy plus the specific form of imaging guidance in a single code. Coding tip: It would be permissible to report one of these imaging codes with an FNA biopsy code if the imaging was used to complete a procedure other than the FNA biopsy or a core needle biopsy on the same lesion during the same encounter.
- If “multiple passes” (i.e., multiple FNA biopsies) are obtained of the same lesion, you will still report only one unit of the FNA biopsy code that describes how that FNA biopsy was obtained. For example, if a surgeon performs an FNA biopsy under CT guidance for a nodule in the left thigh and he makes four passes into that nodule during the procedure to ensure he obtains adequate tissue for pathology, you will code CPT 10009 with only 1 unit. Even though four “passes” were made, he is biopsying just one lesion so you only code 1 unit of the CPT.
- When multiple lesions are addressed with FNA biopsy during the same encounter and all lesions are biopsied using the same type of imaging guidance, you report the primary code for the first lesion biopsied and report the add on code for the second and all additional lesions. For example, if a surgeon performed an FNA biopsy of a nodule in the right thyroid under ultrasound guidance and that same surgeon during the same encounter performs an FNA biopsy of a second nodule in the right thyroid also under ultrasound guidance, you will code CPT 10005 for the first nodule and CPT 10006 for the second nodule.
- When multiple lesions are addressed with FNA biopsy during the same encounter but lesions are biopsied using different types of imaging guidance, you report the primary code for the first lesion biopsied, picking the primary code that accurately describes the type of imaging guidance used, and then you report a second primary CPT code for the additional lesion biopsied using a different type of imaging guidance. Modifier 59 (or modifier XS if your payer like Medicare accepts the EPSU modifiers) will be required on the second primary CPT code to indicate that more than one site was biopsied. For example, if a surgeon performed an FNA biopsy of a nodule in the right thyroid under ultrasound guidance and that same surgeon during the same encounter performs an FNA biopsy of a second nodule in the right thyroid under fluoroscopic guidance, you will code CPT 10007 for the nodule biopsied using fluoroscopic guidance and CPT 10005 with modifier 59 (or modifier XS if the payer like Medicare accepts the EPSU modifiers) for the second nodule biopsied under ultrasound guidance. The coding is changed in this scenario because each nodule was biopsied using a different type of imaging guidance. Coding tip: I decided which CPT code needed the modifier 59 based on the NCCI edits. The modifier 59 would go on the column 2 code (i.e., the potentially bundled code in the NCCI edit pair). You can download a copy of the NCCI edit tables from Medicare’s website at the following link: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html. When you get to the website, download all files that start with “Practitioner PTP Edits v25.0” (there are four files in total). You can also check edits in online coding software like 3M, Encoder Pro, and Supercoder (many coders find this to be an easier method of checking their edits). Just be sure to apply the modifier 59 (or XS) to your column 2 code.
I hope this article helps you to understand the changes for these codes in 2019 and how to use these codes correctly. If you have any questions about this topic or any of the new 2019 CPT codes that you would like to hear more about, head over to the “contact” tab and send me your question. I am always happy to hear from my readers and provide content that will help you in your daily work.
