Radiology Coding Alert

Question: A physician in our outpatient clinic performed an US-guided core needle biopsy of an axillary lymph node mass with a coil placement.

Do I need to report a separate image guidance code?

Kansas Subscriber

Answer: No, you do not need to report the image guidance separately. You’ll assign 10035 (Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion) to report the coil placement. Upon further review of 10035’s descriptor, you’ll notice that the image guidance is included.

Next, you’ll assign 20206 (Biopsy, muscle, percutaneous needle) to report the core needle biopsy of the axillary lymph node mass. A parenthetical note under 20206 instructs you to include 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) or other image guidance codes if imaging guidance is performed. However, reporting 76942 with 20206 and 10035 could result in duplicate image guidance billing since the service is inherently included in 10035.