General Surgery Coding Alert

Question: When our surgeon performs FNA with ultrasound guidance at two anatomic sites on the same day, should we report 10005 with modifier 51?

Wisconsin Subscriber

Answer: No, you should not use modifier 51 (Multiple procedures) in this case.

Here’s why: CPT^® provides different codes for an initial fine needle aspiration (FNA) and any subsequent FNAs for a different anatomic site on a single date of service. Use the following codes:

• 10005 (Fine needle aspiration biopsy, including ultrasound guidance; first lesion)
• +10006 (… each additional lesion (List separately in addition to code for primary procedure))

Medicare states that modifier 51 is appropriate for multiple surgeries or procedures, such as:

• Multiple surgeries performed on the same day, during the same surgical session.
• Diagnostic imaging services subject to the multiple procedure payment reduction that are provided on the same day, during the same session by the same provider.

Caution: You should append the modifier with caution. Don’t use 51 when CPT® provides separate codes for subsequent procedures, such as the FNA example. Also, several Medicare Administrative Contractors (MACs), including Novitas Solutions, advise coders not to use this modifier because their claims software will append it automatically to the correct procedure code as appropriate (https://www. novitas-solutions.com/ webcenter/portal/ MedicareJH/ pagebyid?contentId=00144532). If the payer’s system recognizes and accepts multiple procedures without the modifier, then it will kick back the claim if the modifier is present.