Oncology & Hematology Coding Alert

Question: What is the difference between the codes for fine needle aspiration and puncture aspiration? Missouri Subscriber Answer: Code 19000* (Puncture aspiration of cyst of breast) describes the removal of fluid specifically from a breast cyst. The physician punctures the cyst and withdraws fluid. Afine needle aspiration (10021, Fine needle aspiration; without imaging guidance) may be used to withdraw fluid, but most often it is used to obtain cells from a solid tumor.                                                                        

According to CPTAssistant, a fine needle is defined as a standard 18- to 23-gauge needle. Asmaller needle minimizes bleeding. Afine needle biopsy is differentiated from a percutaneous needle biopsy by the smaller size of the needle. The code for fine needle aspiration was formerly in the pathology section as code 88170. CPT decided to renumber this code in 2002 and move it, along with the bone marrow aspiration and biopsy codes that were also in the pathology section, to the surgery section.                                                                      

The relocation of these codes was prompted by complaints from physicians and their staff that because these codes were in the pathology section, some payers were incorrectly adjudicating claims for these codes as if they were pathology services. Some payers were even insisting that the codes could only be billed by pathologists. Therefore, to promote clarity and ensure that the services represented by these codes were properly recognized as minor surgical procedures, CPT renumbered and relocated the codes to the surgery section. Because the fine needle aspiration codes are not specific to an anatomic site, as the percutaneous needle biopsy codes are, a new section, general surgery, was added to the surgical section to accommodate the fine needle aspiration codes.