General Surgery Coding Alert

An advance look at the 2002 CPT manual reveals several changes that should help general surgery coding and billing. The most important changes include the following:
 
Deletion of fine needle aspiration (FNA) codes from the pathology section, and the introduction of new FNA codes in the integumentary section.
 
Addition of several laparoscopy codes.
 
Addition of new codes for trigger-point injections.
 
Deletion of modifier -60 (altered surgical field).
Dozens of code descriptors have been revised. Although most of the changes are cosmetic (for example, changing the word "bowel" to "intestine"), some are important clarifications that may significantly alter how some general surgeons bill for services.
Fine Needle Aspiration
FNA has two new codes:
  
10021 fine needle aspiration (without imaging guidance)
10022 fine needle aspiration (with imaging guidance).
 
 
FNA does not involve an incision. Instead, a needle is placed into a breast or thyroid mass to remove a sample of cells for examination. FNA is distinguished from other needle biopsies by the thinness of the needle used (usually 18-25 gauge). A cytology report as opposed to a histology report required with other biopsies also must be included within the patient's medical record. Until the introduction of these codes, this service was coded using 88170 (fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]) and 88171 ( deep tissue under radiologic guidance). General surgeons typically performed 88170 on breast and thyroid patients.
 
The introduction of 10021 and 10022 and the deletion of 88170 and 88171 is a positive development because it removes this service, which is frequently performed by general surgeons, from the pathology section of the CPT manual and puts it in the surgical section, says Jan Rasmussen, CPC, a general surgery coding and reimbursement specialist in Eau Claire, Wis.
 
"Transferring FNA to the surgery section should make it easier to find the correct code and eliminate much of the confusion associated with having it in the pathology/lab section while all the other biopsy codes were considered surgical," she says.
 
Deleted codes 88170 and 88171 were broken down into professional and technical components and caused confusion because physicians sometimes had to include modifier -26 (professional component) for aspirating a sample but did not perform the technical component of the service, for example, the cost of the needle and supplies for smear preparation. Typically, modifier -26 had been used when FNA was performed in a facility setting, whereas 88170 or 88171 was billed without a modifier if the surgeon performed the entire procedure and provided the supplies.
 
With the new codes in the surgery section, Rasmussen believes it is unlikely the Medicare fee schedule (due to be released in early November) will maintain the professional/technical split. This should simplify matters for surgeons, who will likely [...]