Radiology Coding Alert

Question: May I code both a core biopsy and FNA performed on the same day?


Maine Subscriber

Answer: Expert opinions differ on the answer to your question, but the CMS National Correct Coding Policy Manual states that you shouldn't report fine needle aspiration (FNA) codes 10021 and 10022 with another biopsy procedure code for the same lesion.

Example: The physician performs an FNA and core biopsy for the same breast lesion during the same encounter, but does not document that the FNA sample was inadequate for diagnosis. The physician performed the services described by 10022 (Fine needle aspiration; with imaging guidance), 19102 (Biopsy of breast; percutan-eous, needle core, using imaging guidance), and 76096 (Mammographic guidance for needle placement, breast [e.g., for wire localization or for injection]). The National Correct Coding Initiative edits bundle 10022 into 19102. If you report them both, you will receive a denial for 10022. Report 19102 and 76096.
 
Very rarely, and with thorough medical-necessity justification, you might be able to report the core biopsy and FNA separately. (CMS suggests that this is possible when one specimen isn't adequate for diagnosis.)

Caution: Remember that needle gauge doesn't determine whether a procedure is a core biopsy or FNA--the technique used and type of specimen obtained determine the type of procedure performed. The physician may obtain cores using "fine needles" or from larger gauge cutting-type needles.