General Surgery Coding Alert

Distinguish first and subsequent lesions.

The two existing codes your general surgeon relies on to report fine needle aspiration (FNA) procedures won’t do the trick come Jan. 1.

That’s because CPT^® 2019 deletes one existing FNA code, revises the other, and adds nine new codes for you to use. Read on to get the lowdown on how to bill for these services next year.

Study FNA Extraction Code Changes

Let’s get started by learning how CPT^® 2019 changes the existing FNA extraction codes, as follows:

• 10021 (Fine needle aspiration biopsy, without imaging guidance; without imaging guidance first lesion) Notice that the revised definition specifies that the FNA is a type of biopsy, and that you should use this code for the first lesion sampled using this method. The code continues to describe an FNA extraction performed without imaging guidance.
• 10022 (… with imaging guidance) CPT^® 2019 deletes this code. Currently, if the pathologist performs the 10022 service, an additional code describes the specific imaging service, such as 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation). That changes on Jan. 1 when you’ll have multiple codes to describe FNA extraction with imaging guidance included.

New codes: Here are the eight new FNA codes that bundle imaging guidance:

• 10005 (Fine needle aspiration biopsy, including ultrasound guidance; first lesion)
• +10006 (… each additional lesion (List separately in addition to code for primary procedure))
• 10007 (Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion)
• +10008 (… each additional lesion (List separately in addition to code for primary procedure))
• 10009 (Fine needle aspiration biopsy, including CT guidance; first lesion)
• +10010 (… each additional lesion (List separately in addition to code for primary procedure))
• 10011 (Fine needle aspiration biopsy, including MR guidance; first lesion)
• +10012 (… each additional lesion (List separately in addition to code for primary procedure)).

“These new codes reflect a change happening throughout CPT^® to include the radiology procedures as part of the primary procedure code, rather than billing separately for them,” says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

Here’s why: “Each year the AMA’s Relativity Assessment Workgroup evaluates potential mis-valued codes to determine whether two codes are performed together at least 75 percent of the time,” says Amanda Corney, MBA, medical billing operations manager for Medical Resources Management in Rochester, New York. “If two codes are typically performed in conjunction with one another, a single combination code that more accurately depicts the services may be created,” Corney explains.

In the case of 10022, the AMA’s Relativity Assessment Workgroup referred the code to the CPT^® Editorial Panel because of findings that certain providers bundle 10022 with ultrasound code 76942 more than 75 percent of the time.

One more new code: You’ll notice that CPT^® 2019 pairs the new “with imaging guidance” codes as a parent code for the first lesion, and an add-on code for each additional lesion. To create the same hierarchy for the “without imaging guidance” code, CPT^® 2019 adds +10004 (Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure)). You should report +10004 in addition to revised code 10021, when appropriate.

Grasp ‘Unit-of-Service’ Change

The addition of “first lesion” and “each additional lesion” to the FNA codes may seem innocuous, but don’t be fooled.

“The changes are going to reduce the number of FNAs that can be billed. You used to be able to bill for every aspiration, although insurers have been increasingly reluctant to pay for obtaining additional samples if the initial sample was inadequate. Also, if the physician felt that it would be helpful to have samples from several locations on the same lesion, each sample could be billed separately,” Bucknam explains. “Now it is clear that, no matter how many samples are obtained or attempted, you may bill only once per lesion,” she says.

Opportunity: The one-code-per lesion restriction doesn’t mean you can’t bill multiple FNA codes in a single day. “If there are multiple lesions, then you can use the add-on codes to indicate that additional lesions are involved,” Bucknam says.

Simplify coding: For coders and practices, the advantage of the revised CPT^® 2019 FNA section is less confusion about why you should bill multiple FNAs. Also, you will no longer need a modifier to indicate that multiple FNAs involve separate lesions.

“The downside is that there is likely to be less reimbursement, and this could be significant for patients with complex anatomy or scarring that might require many sticks or samples to truly identify the problem,” Bucknam says.