Podiatry Coding & Billing Alert

Use a modifier to report FNA separately when appropriate.

CCI version 17.2, which takes effect July 1, offers 2,367 new edit pairs and deletes 336 bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. The majority of edits impact the codes from the musculoskeletal code range (20000-29999), but bundles did occur to codes throughout the CPT® manual.

For instance: Although the CCI previously appeared to do a thorough job of bundling fine needle aspiration (FNA) codes 10021-10022 into most biopsy, excision, and resection codes, the new version of CCI takes it a step further. Effective July 1, you'll find these FNA codes bundled into scores of additional musculoskeletal procedures, including these from the "Excision Procedures on the Foot and Toes" section:

• 28043 -- Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm
• 28039 - ... 1.5 cm or greater
• 28045 -- Excision, tumor, soft tissue of foot or toe, subfascial (e.g., intramuscular); less than 1.5 cm
• 28041 -- ... 1.5 cm or greater
• 28046 -- Radical resection of tumor (e.g., malignant neoplasm), soft tissue of foot or toe; less than 3 cm
• 28047 -- ... 3 cm or greater
• 28171 -- Radical resection of tumor; tarsal (except talus or calcaneus)
• 28173 -- ... metatarsal
• 28175 -- ... phalanx of toe.

"Although CCI already paired many of these services, version 17.2 comes back and fills the gap so that FNA is bundled with all the soft tissue tumor excision and resection codes," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

If the podiatrist can provide documentation that the FNA and other procedure were for separate sites (separate lesions or masses), you can code both services. In that case, you would need to override the CCI edit pair by appending a modifier such as 59 (Distinct procedural service) to the FNA code.