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EXTENSIVE CHANGES TO CODING AND REIMBURSEMENT FOR FINE NEEDLE ASPIRATION (FNA) BIOPSY IN 2019

RADIOLOGY BILLING PERFORMANCE Radiology Billing Radiology Coding Interventional Radiology Coding Interventional Radiology Billing 2019 New Radiology Codes FNA Biopsy

Codes changed along with a reduction in reimbursement. CPT 10022 (RVU 1.88) Fine needle aspiration with imaging guidance was deleted in 2019 but it was replaced with new codes that specified the type of guidance (e.g., ultrasound, fluoro, CT, MR) used. Also, new add-on codes were added for when more than one distinct lesion was treated.


Coding changes:

Prior to 2019, this is how fine needle aspirations of two distinct lesions using ultrasound guidance were coded:

  • 10022 Fine needle aspiration, with imaging guidance
  • 10022-59 Fine needle aspiration, with imaging guidance
  • 76942 Ultrasound guidance for needle placement, imaging supervision and interpretation

 

Beginning 2019, this is how the same procedure must be coded:

  • 10005 Fine needle aspiration biopsy, including ultrasound guidance; first lesion
  • 10006 Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion


Reimbursement changes:

Same example as above, reimbursement differences:

MPFS 2018 GLOBAL

MPFS 2019 GLOBAL

10022

$129.44

10005

$123.48

10022-59

$129.44

10006

$59.82

76942

$58.25

TOTAL

$183.30

TOTAL

$313.13

 

Notice reimbursement drops by $129.83 for the same procedure performed in 2019 – a 41.46% reduction.  It becomes imperative for the provider to document the required specifics to ensure proper coding to avoid further reductions.

 

DOCUMENTATION TIPS:

  • Identify the location of each lesion treated
  • Provide a complete description of each lesion treated
  • When guidance is used, identify the modality (eg, ultrasound, fluoro, CT, MR) for every lesion treated
  • Medical necessity must be documented for every lesion treated


CODING TIPS:

In 2019, CPT, along with the 2019 NCCI Coding Manual, does provide clear-cut information as to how to code these procedures. For starters, CPT defines fine needle aspiration (FNA) biopsies as well as core needle biopsy:

  • Fine needle aspiration (FNA) biopsy is performed when material is aspirated with a fine needle and the cells are examined cytologically
  • Core needle biopsy is typically performed with a larger bore needle to obtain core sample of tissue for histopathologic evaluation

 

New CPT guidelines for FNA biopsy:

  • Imaging guidance codes can no longer be assigned along with FNA procedures
  • When more than one FNA biopsy is performed at separate lesions, same session, same day, same imaging modality, use the appropriate imaging modality add-on code for the second and subsequent lesion(s)
  • When more than one FNA biopsy is performed on separate lesions, same session, same day, using different imaging modalities report the corresponding primary code with modifier 59 for each additional imaging modality and corresponding add-on codes for subsequent lesions sampled
  • This instruction applies regardless of whether the lesions are ipsilateral or contralateral to each other, and/or whether they are in the same or different organ/structures
  • When FNA biopsy and core needle biopsy both are performed on the same lesion, same session, same day using the same type of imaging guidance, do not separately report the imaging guidance for the core needle biopsy
  • When FNA biopsy is performed on one lesion and core needle biopsy is performed on a separate lesion, same session, same day using the same type of imaging guidance, both the core needle biopsy and the imaging guidance for the core needle biopsy may be reported separately with modifier 59
  • When FNA biopsy is performed on one lesion and core needle biopsy is performed on a separate lesion, same session, same day using different types of imaging guidance, both the core needle biopsy and the imaging guidance for the core needle biopsy may be reported with modifier 59


SUMMARY

In 2019, new CPT codes were developed to include the type of imaging guidance used along with corresponding add-on codes for additional lesions treated.  Along with these coding changes were significant reductions in reimbursement.  Because of this, it becomes paramount that the documentation clearly and distinctly describes each lesion treated, the type of guidance used, and medical necessity.  It is also important to review and understand and follow CPT Guidelines for these procedures.

References:

2019 CPT Professional Edition, pages 77 and 78

2018 CPT Professional Edition, page 75

2018 NCCI Policy Manual, Chapter 3, 12.