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Otolaryngology Coding Alert

CPT Pinpoints Fine Needle Aspiration Codes

- Published on Fri, Mar 01, 2002
CPTs introduction of 10021 (Fine needle aspiration; without imaging guidance) and 10022 ( with imaging guidance) and deletion of 88170 (Fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]) and 88171 ( deep tissue under radiologic guidance) should help alleviate some confusion over fine needle aspiration (FNA) coding and billing.
FNA, used to obtain a specimen from an expanding, nonvisible neck, thyroid, parotid or submandibular mass, differs from a needle core biopsy (another procedure used to obtain such a specimen) in that FNA relies on a fine needle (typically 18-25 gauge) to draw cells and fluid from the mass rather than the tip of a needle to collect tissue. Imaging guidance is used to accurately locate the mass, primarily for nonpalpable or cystic lesions. A histology report is not required for an FNA; instead, a cytology report must be included in the patients chart. FNA may be performed because it is less likely to harm the patient than a needle core biopsy or because a more extensive biopsy cannot be taken. The FNA may not collect enough of the specimen to determine a diagnosis, making a more extensive biopsy necessary.
Although there is nothing inherently unusual about FNA from a clinical standpoint, the same cannot be said about coding and billing this procedure, says Elaine Elliott, CPC, a coding and reimbursement specialist in Jensen Beach, Fla.
Relocation in CPT Manual  
One cause of coding confusion was the fact that until Jan. 1, 2002, CPT listed FNA services among codes in the Pathology and Laboratory section (80000 series) rather than the Surgery section (10000-69990 series).
Many otolaryngology practices incorrectly coded FNA procedures either because they did not know of the existence of 88170-88171 (as they were listed in the Pathology and Laboratory section rather than the Surgery section of the CPT Manual) or because they were uncertain about coding and billing guidelines for pathology/laboratory services.
For example, the otolaryngologist would perform an FNA to obtain a specimen from a lymph node and report 38505 (Biopsy or excision of lymph node[s]; by needle, superficial [e.g., cervical, inguinal, axillary]). For image guidance, one of the following radiology codes was erroneously reported: 76360 (Computerized axial tomographic guidance for needle biopsy, radiological supervision and interpretation), 76393 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation]) or 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). FNA of the salivary gland was often reported using 42400 (Biopsy of salivary gland; needle) and thyroid FNAs were incorrectly reported using 60001 [...]

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