# 10022 vs 38505 for FNA biopsy



## djhurt (Aug 2, 2012)

ULSTRASOUND GUIDED LYMPH NODE BIOPSY LEFT NECK

Ultrasound of left neck obtained by the radiologist.  Several small nodes which demonstrate fatty hila normal size.  There is a lobular mildly enlarged node in the posterior triangle which corresponds to the position of the previous  posterior triangle node identified.  This does not demonstrate the normal reniform configuration with the fatty hilum replaced.  Measures approx 6mm.
The procedure discussed with the patient.  Informed consent obtained.  Skin site is marked and prepped usual sterile fashion.  1% lidocaine local anesthesia.  Using ultrasound guidance, numerous fine needle aspiration biopsies obtained of the node.  No complication.
IMPRESSION:  completed FNA biopsy of a posterior traingle node on the left.  Await pathology.

Which code should I bill  10022 or 38505?  Doctor wants to bill 38505 because says it was a biopsy, but there was no incision, so I am questioning which way to go.

Thanks!!


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## rfowler5 (Aug 3, 2012)

Because there was no dictation of mass, we would code FNA w/ult guidance.  But if solid tissue was removed, 36505 would be appropriate however, an addendum would need to by added supporting this coding.


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## donnajrichmond (Aug 3, 2012)

djhurt said:


> ULSTRASOUND GUIDED LYMPH NODE BIOPSY LEFT NECK
> 
> Ultrasound of left neck obtained by the radiologist.  Several small nodes which demonstrate fatty hila normal size.  There is a lobular mildly enlarged node in the posterior triangle which corresponds to the position of the previous  posterior triangle node identified.  This does not demonstrate the normal reniform configuration with the fatty hilum replaced.  Measures approx 6mm.
> The procedure discussed with the patient.  Informed consent obtained.  Skin site is marked and prepped usual sterile fashion.  1% lidocaine local anesthesia.  Using ultrasound guidance, numerous fine needle aspiration biopsies obtained of the node.  No complication.
> ...



This would be 10022 and 76942. 
38505 does not require an incision (nor mass separate from the lymph node), it is needle biopsy of superficial lymph node(s).  However, under 38505 there is a parenthetical note to instruct you to code 10022 for FNA.  Since the report is very clearly documented as FNA, 10022 should be coded.

FNA (10022) can be a biopsy if the intent is to obtain a sample of material to be sent to the lab for cytology or other studies.
It can also be used for aspiration not for biopsy, but that doesn't preclude it from being used for an aspiration biopsy.


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