General Surgery Coding Alert

Question: I-ve always been somewhat confused by the difference between fine needle aspiration (10021-10022) and puncture aspiration (19000-19001). They seem almost identical to me. What differentiates these procedures? Minnesota Subscriber Answer: During fine needle aspiration (FNA), the surgeon uses a fine-gauge needle (from 18 to 25 gauge) and a syringe to sample fluid from a cyst or remove clusters of cells from a solid mass. The surgeon may make several passes to obtain an adequate tissue specimen. Specifically, the fine needle takes out an "aspirate," which is typically a mixture of fluid and cells that the surgeon sends for analysis. You may report these procedures using either 10021 (Fine needle aspiration; without imaging guidance) or 10022 (- with imaging guidance), depending on whether the surgeon uses imaging guidance to obtain the sample. When the surgeon performs a puncture aspiration to evacuate a breast cyst, he may likewise insert a needle into the cyst and withdraw fluid, which he may then send to the lab for cytologic analysis. The procedure's primary function, however, is to treat the cyst, not to sample the cellular composition or "biopsy" the contents. If your doctor performs a puncture aspiration, you should report 19000 (Puncture aspiration of cyst of breast). Use 19001 (... each additional cyst [List separately in addition to code for primary procedure]) when the surgeon performs more than one puncture aspiration on the same breast, and always use 19001 in addition to 19000.