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Fine Needle Aspiration

Published on 

Tuesday, November 27, 2018

 | RAC Information 
 | FAQ 

Q:

I have heard there are a lot of changes for CPT codes for fine needle aspiration (FNA) for 2019. What are those changes?




A:

Currently there are only two CPT codes for fine needle aspiration (FNA):

  • 10021 – FNA without imaging guidance
  • 10022 – FNA with imaging guidance

In 2019, there will be a total of 10 codes for FNA, based on the specific type of imaging guidance used (i.e., ultrasound, fluoroscopy, CT, MRI), and differentiated by initial lesion and each additional lesion.

The descriptions have also been revised to include the word “biopsy”, for a biopsy performed with fine needle technique.

Revised CPT code2018 CPT descriptionSame CPT codeRevised 2019 CPT description
10021FNA without imaging guidance10021*Fine needle aspiration biopsy without imaging guidance, first lesion
  10004Fine needle aspiration biopsy without imaging guidance, each additional lesion
  * Same code as in 2018, but specific to first lesion.  
Deleted CPT codeDeleted CPT descriptionNew codes**New 2019 CPT description
10022FNA with imaging guidance10005FNA biopsy, first lesion including ultrasound guidance
  10006FNA biopsy, each additional lesion including ultrasound guidance
  10007FNA biopsy, first lesion including fluoroscopic guidance
  10008FNA biopsy, each additional lesion including fluoroscopic guidance
  10009FNA biopsy, first lesion including CT guidance
  10010FNA biopsy, each additional lesion including CT guidance
  10011FNA biopsy, first lesion including MR guidance
  10012FNA biopsy, each additional lesion including MR guidance
** New codes are specific to the type of imaging guidance used, and specific to each lesion.
Reminder to Radiology: a CPT code for image guidance cannot be charged in addition to CPT codes 10005 - 10012.

Since the new codes include imaging guidance, a separate CPT code for imaging guidance cannot be reported. This has major implications for Radiology if they have been entering a charge for the procedure plus a separate charge for the guidance – in 2019, the radiology / imaging component is “bundled” into the main procedure.  Ultrasound guidance (76942) is the most common type of guidance used.

In most cases, only one lesion is aspirated. However, when a needle core biopsy is performed in addition to an FNA biopsy, CPT guidelines describe how these should be reported, even breaking it down to specific information about:

  • same lesion,
  • separate lesion(s),
  • same imaging modality,
  • different modality(ies)
  • and instructions on when to use modifier 59.

For Coding / HIM staff who code these procedures:

Keep in mind that in order to report a CPT code that includes imaging guidance, permanently recorded images should be obtained. As you know….whether permanently recorded images are obtained is rarely documented in the procedure note. To confirm this, check with the radiology department to find out if this is their standard procedure.

Example: If an FNA was performed using ultrasound guidance, but permanent images were not recorded, in 2019 you will report revised CPT code 10021 = FNA “without imaging guidance” first lesion. 

Article Author: Jeffery Gordon, RN, MSN, CCA, COC
Jeffery Gordon, RN, MSN, CCA, COC, is the Manager of Outpatient Medical Review at Medical Management Plus, Inc. Jeff has over thirty-five years of experience in healthcare including Critical Care, Infection Control, Quality Assurance, Medical Necessity, Outpatient Coding, Medicare Claims data analysis and Medical Record review.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.