Nine New Codes for Fine Needle Aspirations (FNA)

If your practice performs a lot of fine needle aspirations (FNA), you probably have the code options memorized (10021 without image guidance and 10022with image guidance). However, the 2019 CPT codes now include nine (9) new FNA codes (10004-10012), one deleted FNA code (10022) and one revised FNA code (10021).

Deleted

10022    FNA biopsy with imaging

Revised

10021    FNA biopsy without imaging, first lesion

Added

• FNA biopsy, without imaging guidance: 10021 first lesion and 10004 for each additional lesion
• FNA biopsy, ultrasound guidance: 10005 first lesion and 10006 for each additional lesion
• FNA biopsy, fluoroscopic guidance: 10007 first lesion and 10008 for each additional lesion
• FNA biopsy, CT guidance: 10009 first lesion and 10010 for each additional lesion
• FNA biopsy, MRI guidance: 10011 first lesion and 10012 for each additional lesion

Providers should be updated on the documentation requirements for these new codes including: 

• Type of image guidance used (none, CT, MRI, US, or Fluoroscopy)
• Number and location of lesions biopsied

Although code selection is not determined by anatomic location, documentation of the location is a general medical practice that should be continued for multiple reasons. When more than two lesions are biopsied, the third (or more) should be reported by increasing the quantity (unit value) of the add-on code for “each additional lesion.”

Modifier RT (right) and Modifier LT (left) Right are also not appropriate with these codes, as they are based on quantity and not anatomic location.

Modifier 59 or the X{EPSU} modifiers are also inappropriate when trying to report multiple FNAs, as these are reported with the add-on code. Modifier 59or the X{EPSU} modifiers should only be reported if another procedure (not FNA) was performed during the same operative session for which an NCCI edit exists and the documentation appropriately supports overriding the NCCI edit.

Because it is common to aspirate a single lesion more than once during the same operative session to obtain enough specimen for the pathologist, no matter how many times the needle is introduced into the same lesion, it can only be reported with a single unit of service.

When FNA is performed on a separate lesion, it should be clearly documented (along with any specific type of imaging) and reported with the add-on code (one unit for each additional lesion) rather than an increase in the quantity of the first code. Remember add-on codes require a primary code to be reported with them or they will be denied. Add-On codes in Find-A-Code are identified by a plus symbol  in the right corner, above the code itself. This indicates it must be reported only after a primary code has been reported first.

Example: A fine needle aspiration was performed of two masses located in right lumbar region using fluoroscopic guidance. The first lesion required three passes of the needle to obtain enough specimen for pathology and the second lesion two passes of the needle.  

This would be reported as:

• 10007 fine needle aspiration biopsy, including fluoroscopic guidance, first lesion (quantity 1)
• 10008 fine needle aspiration biopsy, including fluoroscopic guidance, each additional lesion (quantity 1)

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