Ob-Gyn Coding Alert

Although CPT 2002 introduced specific new codes for fine needle aspiration (FNA), those codes didn't clear up much of the confusion about how they apply.
 
When a physician performs an aspiration of a breast cyst but does not perform pathology, questions remain about how the service should be charged and whether to use new or existing codes for the procedure(s).
 
FNA is most often used in the ob/gyn setting to obtain a breast tissue sample for biopsy, or to aspirate a breast cyst. "There still seems to be a lot of uncertainty when it comes to breast aspiration and biopsies," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C., "largely because of the different equipment used."
 
Callaway offers ways to tell the difference between FNA, other aspirations and biopsies:

 1. FNA involves a thin needle extracting a small sample of cells; a cyst aspiration uses a larger needle that extracts all of the contents of a cyst; a biopsy takes a core specimen or a larger piece of the breast mass.

 2. FNA is used as an initial analysis of cyst content; cyst aspiration is used when the cyst becomes painful or large enough to be uncomfortable to the patient; a biopsy is performed when the physician feels there is a very real threat of malignancy.
Puncture Aspiration of Breast Lesion
This method of destroying a breast cyst involves inserting a needle into the cyst and withdrawing the fluid contained in the cyst. The fluid may be sent to the lab for biopsy, depending on the nature of the cyst or cysts. The patient's history will usually determine the physician's decision to have the cyst fluid sent for biopsy. The primary purpose of this procedure, however, is to treat the cyst and not to biopsy the contents.
 
The codes for puncture aspiration are 19000 (Puncture aspiration of cyst of breast) and 19001 ( each additional cyst [list separately in addition to code for primary procedure]).
 
Use 19001 when more than one puncture aspiration is performed on the same breast and always in addition to 19000. Use 19000-50 (Bilateral procedure), rather than 19001, when cysts are aspirated from both breasts.
Fine Needle Aspiration
FNA is used to obtain cells from a solid tumor of the breast, though it may be used for other organs as well. A thin needle is inserted into the breast mass so the syringe can vacuum up cells from the mass.
 
FNA codes listed in the Cytopathology section of the CPT manual were replaced in 2002 with two new codes that more clearly identify FNA as a surgical procedure. "The new codes were created," says Melanie Witt, RN, CPC, MA, an independent coding [...]