Not all the 2019 radiology CPT® codes fall in the 70000 Radiology section. Some radiology-related CPT® code updates are in the Surgery section, including new fine needle aspiration (FNA) codes that include imaging guidance. Here are three tips to help you use the codes for these common services correctly.
1. Choose Your FNA Code Based on Imaging Modality
For FNA CPT® codes, knowing the modality used for imaging guidance is one key to finding the correct codes in your CPT® coding resource.
Ultrasound: When the provider uses ultrasound guidance for the FNA, use 10005 for the first lesion and +10006 for each additional lesion.
Fluoro: The codes for FNA with fluoroscopic guidance are 10007 for the first lesion and +10008 for each additional lesion.
CT: When documentation shows computed tomography guidance for the FNA, use 10009 (first lesion) and +10010 (each additional lesion).
MR: Magnetic resonance guidance is another possibility for FNA, and it earns codes 10011 for the first lesion and +10012 for each additional lesion.
No imaging guidance: In cases where the provider does not use imaging guidance for the FNA, report 10021 for the first lesion and +10004 for each additional lesion. (Of course, with no imaging, these aren’t exactly radiology CPT® codes, but they’re an important part of the FNA code range.)
2. Pay Attention to Number of Lesions for FNA
As you saw in the previous section, the AMA structures the CPT® FNA codes with one code for the first lesion and one code for each additional lesion, pairing them based on modality. Here is an example for ultrasound guidance:
10005 (Fine needle aspiration biopsy, including ultrasound guidance; first lesion)
+10006 (… each additional lesion (List separately in addition to code for primary procedure)).
With this structure, you may wonder if the intention is for you to combine the “first lesion” code for one modality (such as CT) with the “each additional lesion” code for a different modality (such as MR). The answer is no. Here are some tips from the AMA CPT® guidelines:
For multiple FNA biopsies at the same session on separate lesions and using different imaging modalities, append modifier 59 (Distinct procedural service) to the additional primary code or codes you report. (Use the appropriate additional lesion codes after the primary code, too.)
Follow the above rule whether the lesions are on the same side or opposite sides of the body, and whether they are in the same or different organs or structures of the body.
Reporting to CMS? CPT® codes for 2019 have Medically Unlikely Edits (MUEs) to consider when you report to Medicare. For instance, the MUE for +10008 is 3 for the first quarter of 2019. This is a date of service MUE, meaning that if you report the code more than three times on the same date of service, Medicare will deny claim lines for exceeding the MUE. For this MUE, your MAC may reimburse you for the extra units if you appeal, or the MAC may bypass the MUE if you provide documentation that supports medical necessity.
3. Distinguish FNA From Core Needle Biopsy
Just as in previous years, you need to distinguish FNA from core needle biopsy to code correctly. The AMA CPT® definition for FNA biopsy is aspirating material with a fine needle followed by cytological examination of the cells. For core needle biopsy, providers “typically” use a larger bore needle to get a core tissue sample for histopathologic evaluation. Note that the AMA specifies “typically,” meaning that the intent is not for you to use only needle size to determine your code choice.
When you report both FNA and core needle biopsy for the same session, keep these pointers from the CPT® guidelines in mind:
Same lesion, same imaging modality: Don’t report the core needle biopsy imaging separately.
Different lesions, same or different imaging modality: “Both the core needle biopsy and the imaging guidance for the core needle biopsy may be reported separately with modifier 59.”