With recent significant changes in the fine needle aspiration (FNA) biopsy code family, let’s review a few key takeaways. Prior to this year, there were two CPT® codes describing FNA biopsy: 10021 (fine needle aspiration; without imaging guidance) and 10022 (fine needle aspiration; with imaging guidance).
These codes were fairly straightforward. If an FNA biopsy was performed with imaging guidance, it would be appropriate to report a modality-specific guidance code with 10022. If an FNA biopsy was performed without imaging guidance, it would be appropriate to report 10021 – which would be rare for radiology.
As of January 2019, code 10022 was deleted, code 10021 was revised and nine new codes were introduced for FNA biopsy describing modality-specific imaging guidance. In addition, each type of modality-specific guidance code now has two options:
| Imaging Guidance Modality | Primary Code (First Lesion) | Add-On Code (Each Additional Lesion) |
|---|---|---|
| Ultrasound | 10005 | +10006 |
| Fluoroscopy | 10007 | +10008 |
| CT | 10009 | +10010 |
| MR | 10011 | +10012 |
Since these codes include imaging guidance, as expressed in their definitions, separately reporting imaging guidance would not be appropriate. Though unlikely to be seen in radiology, there are also two codes for FNA biopsies performed without imagining guidance: 10021 and +10004.
Per CPT – assign the modality-specific FNA biopsy code and the organ-specific core biopsy code, but do not also assign a separate imaging guidance code used for the core biopsy.
Per the 2019 NCCI narrative instructions, the above guidance would not be correct. Chapter 3, Section L12 instructions were revised for 2019 stating: “12. Fine needle aspiration (FNA) biopsies (CPT codes10004-10012, and 10021) shall not be reported with a biopsy code for the same lesion. For example, an FNA specimen is usually examined for adequacy when the specimen is aspirated. If the specimen is adequate for diagnosis, it is not necessary to obtain an additional biopsy specimen. However, if the specimen is not adequate and another type of biopsy (e.g., needle, open) is subsequently performed at the same patient encounter, the physician shall report only one code, either the biopsy code or the FNA code. (CPT code 10022 was deleted January 1, 2019).”
It is important to be aware of the discrepant guidance and closely monitor payer and NCCI instructions when billing the same type of imaging guidance codes together (i.e., FNA and image-guided core biopsy) to know what is, and what isn’t, appropriate to report.
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