Wiki c6-c7 bx

[gladys font]

What CPT code would I use for C6-C7 biopsy

Using Ct guidance, an 22-gauge needle was inserted into the C6-C7 disk space entering lateral to the left internal carotid artery and internal jugular vein. A single pass was perfomed. The resulting sample was sent for bacteriologic exam and cytology.

Thanking you in advance.
gfont

 

[msncoder]

62267/77012 sounds like what was performed....

 

[RebeccaWoodward*]

What CPT code would I use for C6-C7 biopsy

Using Ct guidance, an 22-gauge needle was inserted into the C6-C7 disk space entering lateral to the left internal carotid artery and internal jugular vein. A single pass was perfomed. The resulting sample was sent for bacteriologic exam and cytology.

Thanking you in advance.
gfont

Just a thought but, depending on complete documentation, maybe 63615.

 

[msncoder]

63615 is performed under stereotactic guidance and since this report says CT guidance you couldn't use this code. Plus if you read the surgical description for 63615 (see below) it doesn't look like what was performed at all.....look at it and tell me what you think.

63615
Stereotactic biopsy, aspiration, or excision of lesion, spinal cord


Lay Description

Lesions in the spinal cord are produced to alleviate chronic pain in a particular area of the body. A common surgery involves creating a lesion in the spinothalamic tracts for pain relief. In this procedure, a stereotactic guidance system is used to enable a physician to conceptualize a position in three-dimensional space. The stereotactic frame is applied to the head with full neck flexion and fixed to the operating table with the patient in the sitting position. Following previously determined coordinates, needles are placed through the C1-C2 interspace. Electrical stimulation and other methods are applied to create a lesion that will block the pain. The needles and the frame are removed. Wounds are dressed. Report 63610 if the stereotactic method is used for a procedure not followed by another; report 63615 if the stereotactic method is used to biopsy, aspirate, or excise a lesion from the spinal cord.

 

[RebeccaWoodward*]

I don't necessarily disagree with you but I'm not sold that 62267 is the best fit. What about 10022?

Fine needle aspiration (FNA) is a percutaneous procedure that uses a fine gauge needle (often 22 or 25 gauge) and a syringe to sample fluid from a cyst or remove clusters of cells from a solid mass. First, the skin is cleansed. If a lump can be felt, the radiologist or surgeon guides a needle into the area by palpating the lump. If the lump is non-palpable, the FNA procedure is performed under image guidance using fluoroscopy, ultrasound, or computed tomography (CT), with the patient positioned according to the area of concern. In fluoroscopic guidance, intermittent fluoroscopy guides the advancement of the needle. Ultrasonography-guided aspiration biopsy involves inserting an aspiration catheter needle device through the accessory channel port of the echoendoscope; the needle is placed into the area to be sampled under endoscopic ultrasonographic guidance. After the needle is placed into the region of the lesion, a vacuum is created and multiple in and out needle motions are performed. Several needle insertions are usually required to ensure that an adequate tissue sample is taken. CT image guidance allows computer-assisted targeting of the area to be sampled. At the completion of the procedure, the needle is withdrawn and a small bandage is placed over the area. Report 10021 if fine needle aspiration is performed without imaging guidance. Report 10022 if imaging guidance is used to assist in locating the lump.

 

[msncoder]

Not that 10022 would be considered incorrect in the event of an audit but CPT 62267 describes what was performed as well. 10022 is a "general" aspiration CPT whereas 62267 is specifically designated for the disc aspiration/biopsy. Since the RVUs for 62267 are double that of 10022 I'd say that the doc would rather use the 62267 especially since they would like to receive the reimbursement they deserve after taking on liability of working with the spinal region where the risks are higher.
I'm attaching another document for 62267 for reference. Again, please do not feel as though I disagree with you completely I just feel that this code would be a better choice in this case but ultimately it's up to the person who is taking responsibility for the billing on which they feel more comfortable submitting.

 

[RebeccaWoodward*]

Anita,

I always welcome a healthy discussion. I work with neurosurgeons and I completley agree that they, as with any provider, should receive credit for services provided. I recommend that gfont speak with her providers and present both codes to see what they feel most represents what was performed. Chances are, they will select 62267 but it's better to be safe than sorry.