# Core Needle Biopsy



## BABS37

Struggling with what to code these procedures when my physician performs them. Any advice?

03/26
Core Needle Biopsy, Left Neck Mass
Neck was prepped and draped. 1% lidocaine was infiltrated. Small incision was made. The core biospy needle was introduced and two tissue cores were harvested and placed in formalin and submitted to pathology.  

04/05 Patient Returned
Ultrasound guided vacuum-assisted core biopsy of neck mass
Neck was prepped. 1% lidocaine was infiltrated. Multi-lobulated subcutaneous mass was identified with Ultrasound and Vacuum actuated core biopsy instrument was inserted through an 11 blade stab incision, positioned adjacent to the mass and fired into the lesion collection a core tissue which was placed in formalin and submitted to pathology. 

Thoughts?


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## chelseab83

Did you get any responses to this or did you figure out what code you would use? i basically have the same thing...mine turned out to be a metastatic squamous  cell carcinoma discovered from the core biopsy

Thanks!


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## sheardmd

We use the FNA code 10021.  Our physicians looked over the descriptions in Encoder Pro and felt that this was the best code.


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## chelseab83

Thanks Melissa!


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## BABS37

Hi Chelseab83- I didn't get a clear cut answer on this. I consulted peers outside of our coding department for a clearer definition and they agreed that 20206 would be appropriate for core biopsy as it has higher RVU's to cover the bigger needles and more work (with the incision) versus FNA so I'm not of any help. 

I agree with Melissa as well that encoder has a nice lay description of FNA I listed below for you in case you don't have a subscription. 

***Fine needle aspiration (FNA) is a percutaneous procedure that uses a fine gauge needle (often 22 or 25 gauge) and a syringe to sample fluid from a cyst or remove clusters of cells from a solid mass. First, the skin is cleansed. If a lump can be felt, the radiologist or surgeon guides a needle into the area by palpating the lump. If the lump is non-palpable, the FNA procedure is performed under image guidance using fluoroscopy, ultrasound, or computed tomography (CT), with the patient positioned according to the area of concern. In fluoroscopic guidance, intermittent fluoroscopy guides the advancement of the needle. Ultrasonography-guided aspiration biopsy involves inserting an aspiration catheter needle device through the accessory channel port of the echoendoscope; the needle is placed into the area to be sampled under endoscopic ultrasonographic guidance. After the needle is placed into the region of the lesion, a vacuum is created and multiple in and out needle motions are performed. Several needle insertions are usually required to ensure that an adequate tissue sample is taken. CT image guidance allows computer-assisted targeting of the area to be sampled. At the completion of the procedure, the needle is withdrawn and a small bandage is placed over the area. Report 10021 if fine needle aspiration is performed without imaging guidance. Report 10022 if imaging guidance is used to assist in locating the lump.***


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