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Nancy Posted 7 Year(s) ago

I have an Endrocrinologist who is performing a FNA of the Thyroid with Unltrasound Guidance. He states in his report that with Ultrasound guidance, 2 passes were made with a 25g needle. To assure adequace the last pass was made using a 18g/core needle. He sent the aspiration as direct smears in alcohol. He is billing this as a 10022-59 & 60100. I was under the understanding that a biopsy would be sent in a speciman jar in formalin and done as a gross examination. The reports would also be different as one would be a cytology report and the other a histology. Please help me with this. Thanks

SuperCoder Posted 7 Year(s) ago

Here,FNA is performed using a small, 25 gauge, needle (larger gauge corresponds to a smaller needle). As per Coding guidelines, a core needle biopsy is performed using an 11-18 gauge needle (larger than the one used in FNA). CNB was indicated when the FNA smears, on immediate assessment, were considered suboptimal or nonrepresentative of clinical and/or radiologic findings or ... CNB also was performed if FNA smears showed features suggestive of malignant lymphoma or sarcoma to facilitate histologic classification, particularly in cases of first-time diagnosis.

It seems from the question that no specimen was sent for exam after 25g needle passes, because of inadequcy. For adequacy 18g needle was used justifying for Core needle biopsy. But sending the aspiration as direct smears in alcohol is the CONTRADICTION.

I would like to cyte some more info that, before the core biopsy specimen was transferred to 10% formalin fixative, cytologic imprints of CNB specimens sometimes were made (available in 12% of cases) by gently touching the CNB tissue to a glass slide. This again may increase the complexity of the issue.

In such a contradictory set of documention and some missing info as in your question, and keeping the guidelines in view, the only deciding factor that is going to serve the purpose is the clinical findings. If the finding is abnormal, particularly if tumor/malignant nodule, etc to decide in favour of Core Biopsy. But, it should not concluded from this that findings from FNA can't be abnormal.

Nancy Posted 7 Year(s) ago

As always, Thank You for your help in this matter. But, as usual I have two other questions. please explain to me the difference between a FNA & PNB. And, when you would you billed the CPT code 10022 or 60100?

SuperCoder Posted 7 Year(s) ago

In general terms, a percutaneous needle biopsy (PNB) procedure entails inserting a needle through the skin and into an area of suspected pathology to retrieve a sample of the tissue or fluid for analysis. The procedure is considered a closed biopsy, as opposed to an open or surgical biopsy. The needle insertion can be nondirected (ie, performed without direct visualization of the target tissue during insertion) or image-guided, using diagnostic imaging to demonstrate the needle placement in the tissue to be sampled. The nondirected technique is used frequently when the lesion is palpable, whereas PNB is performed with image guidance when the lesion is deep-seated and nonpalpable.

Image-guided percutaneous needle biopsy is divided into 2 procedural areas, fine-needle aspiration biopsy (FNAB) and percutaneous core needle biopsy (PCNB), that differ in both process and product. FNAB, also called fine-needle aspiration cytology, is used when cellular specimens are collected from a lesion for cytologic or microbiologic analysis. Small fragments of tissue can be provided by an FNAB, but these fragments often are insufficient for histology purposes. PCNB, also called core needle biopsy, percutaneous core biopsy or percutaneous cutting needle biopsy, is performed when a tissue specimen is required for histologic evaluation. Although the IGPNB procedure is common in current radiologic practice, there has been historical resistance to the procedure as a viable alternative to open, surgical biopsy.

Based on the concept above, you can easily confer where to code 10022 and where to use 60100.

Posted by Nancy, 7 Year(s). There are 4 posts. The latest reply is from SuperCoder.

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