Oncology & Hematology Coding Alert

You could lose more than $62 per procedure if you aren’t specific.

If you’re scratching your head when it comes to fine needle aspiration (FNA) and percutaneous needle biopsy (PNB) procedures, you’re not alone. Your confusion may stem from your physician erroneously reporting biopsy for all procedures where a specimen is obtained with a needle.

Here are tips von 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. That habit could lead you astray as you try to code these procedures.

Better way: Encourage your physician to reserve “biopsy” for procedures that remove a small tissue specimen for diagnosis, whether open, laparoscopic, or percutaneous. If your physician is in that habit, you’ll know you really should look for the appropriate PNB code if the op note shows that 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 that 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: You can use code 10022 even if your physician doesn’t actually perform the imaging guidance. The code simply indicates that the procedure required 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, according to Kristen Taylor, CPC, CHC, managing consultant of reimbursement and advisory services, Altegra Health, Inc.

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 which you can find 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 that 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 that might 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,” reports Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J.

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 as 10021 ($72.72 payment) instead of 55700 ($142.22 payment), that error would cost your practice $69.50 when performing these procedures in hospital and would cost your practice $74.30 when performed in office.

Note: All payment values are based on the unadjusted Medicare Physician Fee Schedule with a conversion factor of 35.8228.