General Surgery Coding Alert

Turn to modifier 59 for aspiration and biopsy at separate locations

If the patient undergoes a more extensive diagnostic surgical procedure at the same site on the same date of service, Medicare may not pay for an initial fine needle aspiration (FNA).

The National Correct Coding Initiative (NCCI) edits bundle FNA with many biopsy procedures under the policy of "sequential procedures." This policy states that when the physician performs a second procedure because the initial procedure did not successfully accomplish a medically necessary service, you should only report the more invasive service.

Example: The physician performs a breast lesion FNA without imaging guidance (10021). Because the FNA results are not conclusive, the physician decides to perform a percutaneous needle biopsy (PNB) of the same lesion (19100). Because NCCI bundles 10021 with 19100 as sequential procedures, Medicare would pay only for the more extensive procedure that accomplished the diagnostic goal - in this case, 19100.

Exception: You can report an FNA (10021) on the same day as a bundled biopsy code - if the FNA and the biopsy involve different anatomic sites or different patient encounters. You should differentiate the services by appending modifier 59 (Distinct procedural service) to the lesser service (in this case, the FNA).

Example: The surgeon performs an incisional biopsy on the left breast and an FNA on the right breast. In this case, you may report both procedures (because they occurred at separate anatomical locations) using 19100 and 10021-59.