Pathology/Lab Coding Alert

Question: How should I code the procedure when our pathologist extracts an FNA of left thyroid lobe nodule and an FNA of thyroid isthumus nodule?

Arkansas Subscriber

Answer: Without more detail, the best coding would probably be 10021 (Fine needle aspiration biopsy, without imaging guidance; first lesion) and +10004 (… each additional lesion…).

Imaging: Because you don’t mention imaging guidance (or lack of it) in your question, a definitive answer isn’t possible. CPT^® provides a series of FNA code pairs for “first lesion” and “each additional lesion” based on imaging guidance, as follows:

• 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; first lesion)
• +10012 (… each additional lesion (List separately in addition to code for primary procedure)).

Your question does make clear that the pathologist is sampling two separate lesions, one from the left thyroid lobe and one from the thyroid isthmus, so you should definitely code two FNAs using the appropriate “first lesion” and “each additional lesion” code pair.

Don’t miss: You used to be able to bill a separate FNA for every aspiration “pass” if pathology reported that the specimen was inadequate, or if the FNA provider felt that it would be helpful to have samples from several locations on the same lesion. With the code changes in CPT^® 2019, it is clear that you can bill an FNA extraction only once per lesion, no matter how many samples the pathologist attempts or obtains.