There is no way to sugarcoat the difficulty of drainage procedures. That is why expert guidance is paramount when facing these scenarios. When it comes to drainage biopsy procedures, fine needle aspiration (FNA) biopsy and core biopsy are essential components. An FNA biopsy uses a thin needle to aspirate cells for cytologic evaluation, whereas a core biopsy removes a larger tissue sample with a wider needle for histologic examination. Proper coding of biopsy procedures requires attention to specific guidelines, including when multiple biopsy codes can be assigned and how imaging guidance impacts coding. The following are questions and answers compiled and reviewed by our nationally renowned subject matter experts providing insight into common challenges experienced by coders across the country.
What is a fine needle aspiration (FNA) biopsy and how is this different from a core biopsy?
FNA biopsy is when material (cells) are aspirated from an area of interest with a needle and the aspirate is sent to the lab for cytologic evaluation. This is different from a core biopsy where core of tissue is being obtained, A core biopsy is most often performed with a larger bore needle to gather a larger (core) amount of tissue which is then sent to the lab for histologic evaluation. Look for aspiration vs. core or needle biopsy, and whether the material obtained is sent to cytology or histology.
Is it ever possible to assign two primary FNA biopsy codes at the same session?
Yes. When two separate lesions are sampled using two different types of modality- specific guidance, each lesion is assigned the modality-specific primary code. Any additional lesions studied using the same type of guidance would be described with the modality-specific add-on code.
Can you code both an FNA biopsy and a core biopsy performed at the same session, on the same lesion, using the same type of imaging guidance?
Per CPT®, assign the modality-specific FNA biopsy code and the organ specific core biopsy code, but do not also assign the separate modality-specific imaging guidance code that was used for the core biopsy.
Be aware that this differs from current NCCI narrative guidance, which states that only one code, the FNA code or the core biopsy code. Check with your payers to determine which is the correct way to code in these situations.
How do you determine when to code a breast cyst aspiration or an FNA biopsy of the breast?
The appropriate FNA code would be assigned when the intent of the procedure was to obtain a sample of cells or fluid for diagnostic evaluation, even if the lesion collapses and turns out to be a cyst. Code 19000 would be assigned if the intent was to drain a cyst, even if the aspirated material is sent to the lab for cytologic evaluation.
How do you determine whether a bone biopsy would be considered superficial (20220) or deep (20225)?
The long descriptions for codes 20220 and 20225 include examples of what would normally fit in the superficial (i.e., ilium, sternum, spinous process, ribs) or deep (i.e., vertebral body, femur) category. The bones listed are not exclusive, if a bone biopsy is performed in another area a good test might be whether the bone can be felt or if it must be found by guidance. When unsure, ask the physician whether they would consider it superficial or deep.
What is the difference between codes 55700 and 55706? They both describe needle biopsy of the prostate; how do you determine which to use?
Both codes do describe needle biopsy of the prostate, but the procedures they are describing are very different. Code 55700 is the standard prostate biopsy which is performed transrectally under ultrasound guidance and local anesthetic with 6 to 12 passes through a lesion in the prostate for sampling – this is the biopsy that is most likely to be performed by an interventional radiologist.
Code 55706 requires general anesthesia and the use of a biopsy grid to sample the entire prostate with up to 60 transperineal samples.
If an injection and an aspiration are performed on the same joint at the same session, is it appropriate to code for both? No, the descriptions for codes 20600-20611 say “aspiration and/or injection,” so it would not be appropriate to assign a code twice if both are performed inthe same joint at the same session.
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