Radiology Coding Alert

Question: The radiologist first used an anterior approach (19-gauge coaxial needle) to a liver lesion, but determined he could not perform the percutaneous needle biopsy from that approach. He then used an oblique approach and took four core specimens from the liver mass. He documented CT guidance. The pathology report documented that the lesion was benign hepatic adenoma. How should I code this report?

Colorado Subscriber

Answer: The appropriate code for the needle biopsy is 47000 (Biopsy of liver, needle; percutaneous).

Tip: CPT® 2012, effective Jan. 1, 2012, adds the moderate sedation symbol to 47000, meaning that the liver biopsy service includes conscious sedation as part of providing the procedure. As a result, the physician who performs the liver biopsy should not separately report 99143-+99145 (Moderate sedation services ...) for services on or after Jan. 1.

In addition to 47000, because the physician documents CT guidance, you should report 77012 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation).

Finally, you should link 47000 and 77012 to 211.5 (Benign neoplasm of liver and biliary passages). A hepatic adenoma is a fairly rare benign tumor. Physicians may order CTs, MRIs, or nuclear medicine studies to identify hepatic lesions, but patients may require biopsy for a specific diagnosis.