# FNA Multiple Bilateral Thyroid Nodules



## baash1124

Can anyone help me with suggestions on how to code for this many multiple bilateral FNA Thyroid nodules?

"....Ultrasound was used to interrogate the thyroid.  The dominant left mid to upper pole heterogeneous nodule was again identified.  The area overlying this region was anesthetized with 1% lidocaine.  Fine needle aspiration was obatained of this lesion and given to pathology for evaluation.  A nodule at approximately 1 cm was seen within the left upper pole with internal calcifications.  This lesion was also FNA in the same fasion.  Susequently, attention was given to the right thyroid gland where there are two large midpole thyroid nodules extending into the lower pole one of which is mixed solid cystic and the other, which is more solid in appearance with mixed hypo and hyperechoic regions.  A third lesion was seen within the upper pole measureing approximately 1 cm with internal calcifications.  These lesions also FNA.  There is a total of two left and three right nodules fine needle aspirated as described above.  Needle access was documented with ultrasound."

I know to use 10022 and 76942 I just wasn't sure if I could bill for all 5 and what modifiers I could use. 

Thanks in advance.


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## smwaters

We do these a lot and our guideline is that if they clearly dictate a seperate needle was used for each FNA to seperately submit the fluid then we code each individually.  If they are vague or don't specify, we only code once.  This particular report doesn't appear to specify that each FNA was separately submitted.  Hope this helps for the future!


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## prabha

Since seperate access site is not clearly mentioned, I think we can code code this once for left side and once for right side as,
   10022   
   76942-26
   10022-59
   76942-2659


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## tsunderman

prabha said:


> Since seperate access site is not clearly mentioned, I think we can code code this once for left side and once for right side as,
> 10022
> 76942-26
> 10022-59
> 76942-2659



You must have 2 or more diagnosis to use modifier 25 for FNA.
Several nodules can be billed separately.
Use modifier LT and RT and 51 (multiple procedures)
If you have more than one Ultrasound use modifier 59.
Also new code for 2012 88177.  Usually there are three passes taken for adequecy.  Use code 88177 for additional passes.


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## donnajrichmond

88177 is for the cytologic evaluation, not for the biopsy itself. 

If this is a Medicare patient, or a patient who's insurance follows Medicare guidelines, you can only code 76942 once, but you can code 10022 for each separately identifiable lesion/nodule that is aspirated.


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## Rajebpt

Hi,

We can bill 5 times 10022 with mod 59 and 76942 can be billed once for MC patient.


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