Orthopedic Coding Alert

Question: Our providers sometimes must perform fine needle aspirations (FNAs) for patients who require other services from the orthopedist as well. I have read that there are some FNA code changes in CPT® 2019, but I haven’t gotten a full rundown. How will FNA coding change in 2019?

California Subscriber

Answer: CPT^® has a lot of changes in store for the FNA code set, which will multiply greatly from its current two-code state.

The overhaul of the FNA code family features one revision, one deletion, and a slew of newer, more specific FNA codes.

Revision: In 2019, the base FNA code 10021 (Fine needle aspiration biopsy, without imaging guidance) will read (Fine needle aspiration biopsy, without imaging guidance; first lesion.) The bolded words are new for 2019 and reflect the fact that CPT^® is creating additional add-on codes to reflect additional lesions that the physician might treat.

Deletion: The 10022 (Fine needle aspiration; with imaging guidance) code didn’t make the CPT^® cut for 2019. The American Medical Association’s Relativity Assessment Workgroup identified it “as being reported together with [ultrasound code] 76942 [Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation] more than 75 percent of the time, resulting in referral to the CPT^® Editorial Panel for a bundling,” according to the American College of Radiology’s website.

Additions: These new codes, designed to reflect guidance type and additional lesions, will be active on January 1:

• +10004 — … each additional lesion (List separately in addition to code for primary procedure)
• 10005 — Fine needle aspiration biopsy, including ultrasound guidance; first lesion
• +10006 — … each additional lesion (List separately in addition to code for primary procedure)
• 10007 — Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
• +10008 — … each additional lesion (List separately in addition to code for primary procedure)
• 10009 — Fine needle aspiration biopsy, including CT guidance; first lesion
• +10010 — … each additional lesion (List separately in addition to code for primary procedure)
• 10011 — Fine needle aspiration biopsy, including MR guidance
• +10012 — … each additional lesion (List separately in addition to code for primary procedure).