Radiology Coding Alert

Question: We will be doing fine needle biopsies in our office, which is an independent facility not connected with a hospital. The only codes I can find for this procedure are 76938 (ultrasonic guidance for cyst [any location] or renal pelvis aspiration, radiological supervision and interpretation) and 76942 (ultrasonic guidance for needle biopsy, radiological supervision and interpretation). Can I use these in conjunction with each other or only assign them separately? Is there another option I should consider?

Oklahoma Subscriber

Answer: The two guidance codes may be used together if both a cyst was aspirated and a biopsy was performed on two separate lesions. If a single lesion was sampled, only one of the two guidance codes should be used. There are also CT (76360, computerized tomography guidance for needle biopsy, radiological supervision and interpretation) and fluoroscopic (76003, fluoroscopic localization for needle biopsy or fine needle aspiration) codes that could be reported, if those guidance methods were used.

Interestingly, there is disagreement about how to assign procedural codes for fine needle biopsies. Some coders recommend 88171 (fine needle aspiration with or without preparation of smears; deep tissue under radiologic guidance). The note in CPT under 88171 directs you to use one of three codes to report the imaging portion of the total procedure, depending on the type of imaging used. These would be 76942, 76360 or 76003.

The Society for Cardiovascular and Interventional Radiology does not advocate using 88171 for percutaneous needle biopsies for a number of reasons. First, this code was originally placed in the pathology section of the CPT manual because some pathologists performed fine needle aspirations with immediate on-site slide preparation and review.

Second, although this code could be used for some needle biopsies, it should be used only if a needle biopsy code for a specific anatomical area is nonexistent. There are surgical percutaneous needle biopsy codes scattered throughout the CPT manual in each of the anatomic areas (e.g., pulmonary, breast, bone, liver, renal, musculoskeletal, node, thyroid).

You Be the Coder and Reader Questions were answered by Andrea Lamb, CPC, billing clerk for St. Josephs Medical Plaza, a multispeciality group practice in Buckhannon, W.Va.; and Scott Roberson, CPC, CPC-H, APC, senior compliance coding consultant at Intermountain Health Care, a multispecialty practice in Salt Lake City.