Otolaryngology Coding Alert

How to find PNB codes: Look for the anatomic site-specific surgery code, instructs Ritter.

Example: An otolaryngologists takes a percutaneous biopsy of the salivary gland. When you look in the digestive system under the subheading "salivary gland and ducts," you find 42400 (Biopsy of salivary gland; needle), Ritter points out.
 
Speed tip: To quickly locate an exact PNB code, look up "needle biopsy" in CPT's index. Find the anatomical location the surgeon biopsied, such as the "thyroid gland," and, voila, you have the code: 60100 (Biopsy thyroid; percutaneous core needle).

Editor's note: For a list of PNB codes that otolaryngologists commonly use, see "1 Easy Way to Keep FNA and PNB Straight".

Biopsy Involves Larger Needle, Specimen

To determine whether you should be using an integumentary system code or an anatomic-specific code, look at two key differences between a FNB and PNB.

1. Consider the needle's size. "A percutaneous needle is much larger than a fine needle," reports Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.

2. Check the specimen's type. "A fine needle takes out an 'aspirate,' which is a sort of fluid that the otolaryngologist sends for analysis," Cobuzzi says. "A percutaneous needle is larger and takes out tissue in the mass's core."

Key terms: You should associate fluid or cell sampling with FNA and core or tissue sampling with PNB.

In FNA, the physician uses "a fine gauge needle (22 or 25 gauge) and a syringe to sample fluid from a cyst or remove clusters of cells from a solid mass," states Ingenix's Coding Companion. The sampling may involve several needle insertions to obtain an adequate tissue specimen.

On the other hand, PNB involves a single insertion. The otolaryngologist "uses the tip of a needle to collect tissue," says Ritter. Specifically, to remove "tissue from the thyroid for examination" the physician passes "a large, hollow bore needle ... through the skin into the thyroid," according to Ingenix's Coding Companion.
 
Guidance, Cytology Report Signal FNA

You can further solidify your biopsy versus aspiration code selection if you look at a related service.

Here's how: Check whether the otolaryngologist needed imaging guidance to locate the mass. If he did, he performed FNA.

When the surgeon can feel the lump, he usually doesn't require imaging guidance. You should code FNA without imaging guidance as 10021.

If the lump is nonpalpable, the otolaryngologist will use image guidance to perform the FNA. In this case, report 10022 for the FNA with imaging guidance.

Don't be fooled: You can use code 10022 even if your otolaryngologist doesn't actually perform the imaging guidance himself. The code simply indicates that the procedure required imaging guidance - the code does not include the imaging service.

For example, the medical record may state the otolaryngologist performed the FNA in a radiology unit so another provider could perform the imaging guidance. In this case, you'd report 10022. In a radiology unit, the radiologist will report the imaging guidance with the appropriate code, such as 76942 (Ultrasonic guidance for needle placement, imaging supervision and interpretation).

If your otolaryngologist performs the FNA and imaging guidance himself, you should report both 10022 and the appropriate guidance code, as follows:
 

Clever idea: A check of any reports the patient's chart contains will also help you select the right code. A cytology report from the pathologist indicates the patient had an FNA. If you find a histology report, code a PNB.