Sail Safely Through FNA Coding With 3 Steps

Hint: Don't forget modifier -25 to secure payment for same-day consultations

If you think reporting an FNA is as simple as selecting 10021 or 10022, think again.

Endocrinologists frequently perform a fine needle aspiration (FNA) for thyroid biopsy, and you need to know what codes and modifiers will recoup the approximately $150 to $160 your physician deserves for the service.

To report an FNA correctly every time, follow these three steps for success:

1. Determine with or without imaging guidance. If your endocrinologist performs an FNA without imaging guidance, report 10021 (Fine needle aspiration; without imaging guidance). If the physician uses imaging guidance - such as ultrasound - to perform the FNA, you should report 10022 (Fine needle aspiration; with imaging guidance).

Don't be fooled: You can use code 10022 even if your physician doesn't actually perform the imaging guidance himself. The code simply indicates that the procedure required imaging guidance - the code does not include the imaging service. For example, the medical record may state the physician performed the FNA in a radiology unit so another provider could perform the imaging guidance, in which case you'd report 10022. In a radiology unit, the radiologist will report the imaging guidance with the appropriate code, such as 76942 (Ultrasonic guidance for needle placement, imaging supervision and interpretation).

Note: If your physician performs the FNA and imaging guidance himself, you should report both 10022 and 76942.
2. Select the appropriate-level E/M code if the physician examined the patient before deciding to perform the FNA. Most times a patient's primary-care physician will identify a thyroid nodule and send the patient to an endocrinologist for consultation, says David Lobach, MD, an endocrinologist at Duke University Medical Center in Durham, N.C. The endocrinologist then determines if the patient has a worrisome nodule that requires biopsy.

High-level visit: In this situation, "our endocrinologist generally reports a level-four or -five consultation," says Sherri L. Gerety, CPC, financial systems supervisor for Wichita Clinic, a large multi-specialty clinic with four endocrinologists in Wichita, Kan.

Don't assume: Be careful not to automatically assume that such visits merit a level-four or -five code. The physician must carefully document the history, exam and medical decision-making to justify a high level of service.

No E/M when: You shouldn't report an E/M code if the physician scheduled the FNA in advance and it's the only service he renders that day, Gerety says.

3. Append modifier -25. If you report an FNA and an E/M visit, you will have to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to recoup payment for both services, Gerety says.

Example: A patient's primary-care [...]

- Published on 2004-09-23