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NCCI / 59 modifier issues for 2019 cpt codes

Janet Posted Wed 13th of February, 2019 10:01:43 AM
Does anyone have any suggestions on how we should code the new Biopsy codes for 2019 with the current CCI edits. Should we follow SuperCoder or the CMS website? Has anyone else seen this issue? Thanks, Janet
SuperCoder Answered Thu 14th of February, 2019 07:23:14 AM

Hi Janet,


Thanks for your question.


The 2019 CPT® code set revises 10021 to add "first lesion" to the descriptor and adds new add-on code +10004 for each additional lesion (List separately in addition to code for primary procedure). Now, instead of reporting 10021 for any number of lesions biopsied by fine needle aspiration, you will report 10021 for the first lesion and +10004 times the number of additional lesions.


The 2019 code set deletes 10022 (fine needle aspiration; with imaging guidance), that was used before Jan 1, 2019 to report the procedure with imaging guidance and adds a number of new codes (10004-10012) for fine needle aspiration with imaging guidance that specify the type of imaging guidance used:


  1. 10021 - Fine needle aspiration biopsy, without imaging guidance; first lesion
  2. +10004 - … each additional lesion…
  3. 10005 - Fine needle aspiration biopsy, including ultrasound guidance, first lesion
  4. +10006 - … each additional lesion…
  5. 10007 - Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
  6. +10008 - each additional lesion…
  7. 10009 - Fine needle aspiration biopsy, including CT guidance; first lesion
  8. +10010 - … each additional lesion…
  9. 10011 - Fine needle aspiration biopsy, including MR guidance; first lesion
  10. +10012 - … each additional lesion…


Please feel free to write if you have any question.



Janet Posted Thu 14th of February, 2019 09:46:25 AM
This is actually regarding the codes of 11102,11104 and 11106 when billed with the 17000 and 17004. I believe there were questions as to which codes the 59 modifier should be added to according to NCCi and the NCCI Manual.
SuperCoder Answered Fri 15th of February, 2019 02:10:53 AM



For reporting codes 11102,11104, or 11106 with codes 17000 or 17004. There is CCI edit of codes (11102,11104, 11106) with codes (17000, 17004) but a modifier is allowed. This means you may report both codes but only when both procedures are performed on different lesions on the same date of service. Modifier 59 should be appended with biopsy codes.


We hope this answers your question.



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