Question: Our endocrinologist performed an ultrasound scan to find a thyroid nodule and then decided to do a fine needle aspiration with ultrasonic guidance. He also performed an E/M office visit. How should I code for the visit?
Pennsylvania Subscriber
Answer: If your physician performed a separately identifiable E/M service to assess the patient's condition before deciding to do the scanning ultrasound, you should report the appropriate-level E/M code, such as 99213, with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to inform the carrier that this service deserves separate payment.
You should report the fine needle aspiration (FNA) with 10022 (Fine needle aspiration; with imaging guidance) and report the imaging guidance for the procedure with 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).
For the preliminary ultrasound scan to detect the nodule, you should use 76536 (Ultrasound, soft tissues of head and neck [e.g., thyroid, parathyroid, parotid], B-scan and/or real time with image documentation) and append modifier -59 (Distinct procedural service) to let the carrier know that this ultrasound service is separately payable because it's different from the ultrasonic guidance with the FNA.
