Resolved CPT Guidelines: FNA Biopsy

[KalliP_67450]

Question: In the CPT guidelines, it says "When FNA and core needle biopsy are performed on the same lesion, same session, same day with same type of imaging, do not separately report the imaging guidance for the core needle biopsy.” Does this mean only one code will be reported for that one lesion as FNA code or will FNA and the core needle biopsy be coded and just not the guidance for the core biopsy?? I have looked up online, it is giving me mixed directions of how I should code for the test versus real life. Which one should I follow for taking the CPC? Thanks!

This is the website that is giving me mixed directions about real-life versus test-taking. It is saying you only report the core needle biopsy and the corresponding imaging and NOT the FNA.
https://www.aapc.com/blog/46771-how-to-be-the-best-fine-needle-aspiration-and-core-biopsy-coder/

 

[Alicia]

"When FNA and core needle biopsy are performed on the same lesion, same session, same day with same type of imaging, do not separately report the imaging guidance for the core needle biopsy.”

I feel your pain and know it gets confusing. For testing purposes go by what the guidelines state as that is what you are being tested on...the guidelines. Now to answer your question. This is a little thing called "double dipping". Think of the scenario. Patient comes in and has a FNA done but it is not enough to get a determination of what they need. The provider decides to switch to a core needle biopsy. The guidance is already set up and used again. You do not get to code for the guidance twice. Now these are codes I pulled off the top of my head. Without seeing a scenario I can't tell you more. You would loose the FNA and code the Core Needle. Depending on which code was used would determine if you added the guidance code or not. For this one 10005 has guidance included. If you loose that code then you have to add it for the 60100.

10005 - Fine needle aspiration biopsy, including ultrasound guidance; first lesion​

60100 - Biopsy thyroid, percutaneous core needle

76942 - Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation

 

[KalliP_67450]

Okay thank you!! That definitely helps.