General Surgery Coding Alert

Question: I'm trying to code a claim for a "fine needle" prostate biopsy procedure, but I'm not sure how to proceed. Please help.

Codify Subscriber

Answer: You provide some possibly contradictory information in your question, and if that reflects the op report, it may explain your difficulty in assigning the correct code.

Two directions: When using a needle to sample the prostate gland, a surgeon might take one of two paths. The surgeon might take a prostate needle biopsy (PNB) specimen, which is a small piece of tissue extracted through a hollow-core needle. Or, a surgeon might take a fine needle aspiration (FNA) specimen, which is a fluid "aspirate" of cells extracted from the organ through a small needle.

Depending on the needle procedure, you would report one of the following codes:

• 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach)
• 10021 (Fine needle aspiration; without imaging guidance)
• 10022 (... with imaging guidance).

To help you distinguish which procedure your surgeon performed, you can look for the following items in the op report:

Approach: For a PNB, a surgeon will almost always do a transrectal or perineal approach to obtain a needle prostate biopsy for analysis.

Specimen: You should associate fluid or cell sampling with FNA and core or tissue sampling with PNB. See the surgeon's description of the specimen to help you choose the right code. Also note that the pathology report can help clarify the type of specimen, and you should be waiting for that report before assigning diagnoses anyway.

Needle size: A percutaneous needle, which the surgeon uses to extract tissue, is much larger than a fine needle, which the surgeon uses to extract a fluid aspirate.

Payment implications: Missing the proper code for a prostate specimen could result in leaving money on the table - or overcharging for a service that could turn up on audit and require re-payment. Specifically, Medicare's non-facility national payment amount for 10021 is $124.53, while payment for 55700 is $253.37 (2017 Medicare Physician Fee Schedule, conversion factor 35.8887).