Oncology & Hematology Coding Alert

Watch out, or your mistake will cost you $64 per procedure.

If your oncologist merely documents "biopsy" for procedures where he obtains a specimen via a needle, then you could be finding yourself in limbo as to whether to report a fine needle aspiration (FNA) or a percutaneous needle biopsy (PNB).

Here are tips on how you can steer clear of coding errors for these two procedures.

Tip 1: Watch Your Language

Your physicians may use "biopsy" as a universal term to mean they took a sample of a specimen. Bad habits could lead you astray as you try to code these procedures.

Better way:  Encourage your physician to reserve "biopsy" for procedures to remove a small tissue specimen for diagnosis, whether open, laparoscopic, or percutaneous. If the physician has this habit, you'll know you really should look for the appropriate PNB code if the op note shows a needle is involved.

If your physician removes cellular material in an "aspirate" instead of tissue in a biopsy, you need to turn to the FNA codes.

Helpful hint: You code for FNA when your physician does an aspiration of the testis or epididymis. Your physician may also use PNB for these organs. For the prostate, your physician may almost always do a transrectal or perineal PNB to obtain prostatic material for analysis.

However, if your physicians continue to use contradictory language, a few hints will help you tell the procedures apart.

Tip 2: Procedures Have Own Sections

FNA and PNB are so different CPT^® actually places the procedures in separate sections.

FNA has its own codes, which are found in the integumentary section. CPT® defines these codes as:

• 10021 (Fine needle aspiration; without imaging guidance)
• 10022 (...;with imaging guidance).

Don't be fooled: Code 10022 simply indicates that the procedure required imaging guidance. You can use code 10022 even if your physician doesn't personally perform the imaging guidance. The code does not include the imaging service. When image guidance is medically necessary, performed and documented by the physician performing the FNA, you report an additional code from the radiology section.

How to find PNB codes: Look for the anatomic site-specific surgery code.

Example: Your surgeon takes a percutaneous needle biopsy of the prostate. The most specific code available is one for the "incision procedures of the prostate." You report code 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach) for the PNB of the prostate.

Speed tip: To quickly locate an exact PNB code, look up "needle biopsy" in CPT®'s index. Find the anatomical location your physician biopsied, such as the "epididymis," and, presto, you can look up the specific CPT^®  code to ensure it matches the procedure performed and documented. For biopsy of the epididymis, you would use 54800 (Biopsy of epididymis, needle).

Note: Your physician does not have to indicate the word "percutaneous." Stating a "needle biopsy" in the procedure description is sufficient.

Tip 3: Biopsy Involves Larger Needle, Tissue Specimen

Other hints in the operative note to help you distinguish a FNA from a PNB are the needle's size and the specimen type.

"A percutaneous needle is much larger than a fine needle," Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow and vice president at Stark Coding & Consulting LLC, in Shrewsbury, New Jersey.

Specimen: "A fine needle takes out an 'aspirate,' which is a sort of fluid that is sent to the pathologist for analysis," Cobuzzi says. "A percutaneous needle is larger and takes out tissue in the mass's core."

Key terms: You should associate fluid or cell sampling with FNA and core or tissue sampling with PNB.

Mistakes could cost you: If you miscode a PNB as an FNA, you stand to lose significant pay. For instance, if you had reported the earlier prostate example, the national average reimbursement for 10021 is $71.78 and 55700 is $136.02. This error would cost your practice $64.24 when performing these procedures in hospital. When performed in the office, it could cost your practice $128.84.

Note: All payment values are based on the unadjusted Medicare Physician Fee Schedule with a conversion factor of 35.8887.