General Surgery Coding Alert

Question: Our surgeon performed an FNA on a palpable 2 cm nodule of the right thyroid lobe. The pathologist found insufficient cells in the specimen, and reported the finding back to our surgeon, who performed a second FNA at the site. The surgeon then performed an ultrasound study, identified a 1 cm nodule of the thyroid isthmus, and extracted a third FNA specimen from this site under ultrasound guidance. How should we code the surgeon’s work?

Tennessee Subscriber

Answer: You should report the two Fine Needle Aspiration (FNA) passes from the palpable right thyroid nodule using 10021 (Fine needle aspiration; without imaging guidance). Additionally, you should report the ultrasound-guided FNA of the thyroid isthmus as 10022 (…with imaging guidance), plus the appropriate radiology code such as 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). You should append 59 (Distinct procedural service) or similar appropriate modifier to 10021, because it is a column 2 code with 10022 in the Correct Coding Initiative (CCI) edits.

Because the surgeon performs two passes from the same nodule in the same operative session, you should bill only one unit of 10021 for the two FNA passes to the palpable right thyroid nodule.

On the other hand, the image-guided FNA takes place at a different site — a separate nodule of the thyroid isthmus — so you can separately report the service using 10022. Because CCI bundles 10021 and 10022, you’ll need to use the modifier on the column 2 code to override the edit pair.