Oncology & Hematology Coding Alert

Coding Quiz Answers:

Check Your Answers to Our Year-in-Review Coding Quiz

Published on Wed Nov 24, 2021

Here’s the modifier you need to apply to each additional lesion.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1: CPT^® 2021 introduced 32408 (Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed). According to CPT^® Assistant Volume 31: Issue 4 (2021), “because lung and mediastinum percutaneous core needle biopsies are typically performed with imaging guidance, code 32405 (Biopsy, lung or mediastinum, percutaneous needle) was deleted and replaced with code 32408, which includes imaging guidance, when performed.”

So, it would be incorrect to separately report any of the following imaging guidance codes with 32408:

76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation)
77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure))
77012 (Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation)
77021 (Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation).

The CPT^® Assistant article goes on to restate CPT^® guidelines telling you “code 32408 includes all imaging guidance regardless of the number of imaging modalities used on the same lesion during the same session.” It also restates the following guidelines for multiple core needle and fine needle aspiration (FNA) biopsies when performed at the same session:

To code multiple core needle lung/mediastinum biopsies on separate lesions: Report 32408 once for each biopsy of each lesion and use modifier 59 (Distinct procedural service) for each additional lesion.

To code multiple core needle lung/mediastinum biopsies with core needle biopsies of other sites: Report 32408 once for each biopsy of each lesion, then code the core needle biopsies of other sites separately with modifier 59.

To code a core needle lung/mediastinum biopsy with an FNA biopsy with image guidance on the same lesion: Report 32408 and the appropriate FNA biopsy code and append modifier 52 (Reduced services) to either of the codes.

To code a core needle lung/mediastinum biopsy with an FNA biopsy with different types of image guidance on the same lesion: Report 32408 and the appropriate FNA biopsy code and append modifier 59 to one of the codes.

To code a core needle lung/mediastinum biopsy with an FNA biopsy with the same type of image guidance on different lesions: Report 32408 and the appropriate modality-specific image-guided FNA biopsy code and append modifier 59 to one of the codes.

To code a core needle lung/mediastinum biopsy with an FNA biopsy with different types of image guidance on different lesions: Report 32408 and the appropriate modality-specific image-guided FNA biopsy code and append modifier 59 to one of the codes.

Answer 2: On Oct. 1, 2021, ICD-10-CM made a new diagnosis code — C84.7A (Anaplastic large cell lymphoma, ALK-negative, breast) — effective for use. “The code came with the synonym of breast implant associated anaplastic large cell lymphoma (BIA-ALCL),” noted Amy Pritchett, CCS, CPC-I, CPMA, CDEO, CASCC, CANPC, CRC, CDEC, CMPM, C-AHI, Senior Consultant at Pinnacle Enterprise Risk Consulting Services LLC, Centennial, Colorado at the time of its introduction.

Guidelines for the code include “Use additional notes telling you to use Z98.82 (Breast implant status) and Z98.86 (Personal history of breast implant removal),” said Pritchett. Additionally, ICD-10-CM added a further guideline, I.C.2.s, which tells you not to “assign a complication code from chapter 19 [Injury, poisoning and certain other consequences of external causes].”

In other words, because BIA-ALCL is “a type of non-Hodgkin’s lymphoma (cancer of the immune system) … found in the scar tissue and fluid near the implant [that] can spread throughout the body” (Source: www.fda.gov/medical-devices/breast-implants/questions-and-answers-about-breast-implant-associated-anaplastic-large-cell-lymphoma-bia-alcl) and not a complication of a breast implant after rupturing or malfunctioning, you cannot use a code such as T85.79- (Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts) or T85.43- (Leakage of breast prosthesis and implant) with C84.7A.

Answer 3: In Oncology and Hematology Coding Alert volume 23 number 10, we reported that mRNA technology promises to “accurately predict whether patients had responded to previous treatment with targeted therapy or immunotherapy,” enabling providers to “match … patients to beneficial treatments” more accurately than ever before (Source: www.cancer.gov/news-events/cancer-currents-blog/2020/tumor-rna-cancer-precision-medicine).

This led to the production of two new tests: 81523 (Oncology (breast), mRNA, next-generation sequencing gene expression profiling of 70 content genes and 31 housekeeping genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk to distant metastasis), which will help predict whether patients will respond to certain breast cancer therapies, and 0262U (Oncology (solid tumor), gene expression profiling by real-time RT-PCR of 7 gene pathways (ER, AR, PI3K, MAPK, HH, TGFB, Notch), formalin-fixed paraffin-embedded (FFPE), algorithm reported as gene pathway activity score), which measures mRNA expression patterns in signaling pathways driving tumor growth. The test may help determine specific targeted therapies for solid tumors in the breast, prostate, or ovaries, or for colon cancer.

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