Oncology & Hematology Coding Alert

Question: What code(s) should I use for an ultrasound-guided core needle biopsy of an axillary mass with a coil placement? Should I use 10005?

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Answer: In this particular situation, it would be wrong to use 10005 (Fine needle aspiration biopsy, including ultrasound guidance; first lesion) to describe the procedure, as this code would be used to describe a fine needle aspiration (FNA) biopsy, and you have indicated the provider performed a core needle biopsy.

But given what you have said, you should query the doctor for clarification. You say that the biopsy was on an axillary mass, and most biopsies that involve a marker insertion are for lymph nodes. With this in mind, your coding would resemble one of the following:

For an axillary mass biopsy with marker placement: Use 20206 (Biopsy, muscle, percutaneous needle) with 10035 (Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion) for the marker placement.

For a lymph node biopsy with marker placement: Use 38505 (Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)) with 10035 for the marker placement.

Note that the marker placement code includes the ultrasound (US) guidance, so if either the 20206 or 38505 biopsy includes marker placement, you would not code the US guidance separately. If no marker was placed, you would swap out 10035 for 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) for the US guidance on its own.