Perfect Your FNA Coding With 2 Little-Known Guidelines

You may be losing money if you report only the regular FNA code

Confusion over how to report multiple passes and multiple thyroid nodules during an FNA can cost you - up to $75 per patient.

As is turns out, the key to higher payment is not multiple passes, but rather multiple nodules. Here's the breakdown:

1. For several needle passes through the same nodule, you should report 10021 or 10022 only once, says Sethu K. Reddy, MD, MBA, chairman of endocrinology, diabetes and metabolism at the Cleveland Clinic Foundation in Ohio.

2. "If the physician biopsies a second nodule, for instance on the other side, then he should code separately for both, using a modifier -50," says Reddy, who is also the committee chairman of the American Association of Clinical Endocrinologists (AACE) Coding Committee.

Example: Your endocrinologist performs an FNA without imaging guidance. He makes five passes through a right-sided nodule and three passes through a left-sided nodule. You should report 10021-50. Modifier -50 (Bilateral procedure) will increase your reimbursement by 50 percent. Payers normally reimburse about $150 to $160 for a regular FNA code, meaning you deserve about $75 more for the bilateral procedure - a total of about $225 to $235.
Use 60001 for Pure Aspiration Only
A physician should only report 60001 (Aspiration and/or injection, thyroid cyst) for pure aspiration or if the physician injects the cyst with pure sterile ethanol, "which is commonly performed in Europe and is being promoted in the U.S.," Reddy says. Physicians rarely perform a pure aspiration simply to remove fluid because you should send all aspirated fluid to cytology, and that classifies the procedure as an FNA for biopsy purposes, he adds.

FNA and 60001: One scenario might merit both codes, Reddy says: You could reasonably report 10021 or 10022 for an FNA biopsy and then 60001 for a cyst injection.

- Published on 2004-09-23