Oncology & Hematology Coding Alert

You Be the Coder:

Watch for Bundle in Thyroid FNA and Needle Biopsy Coding

Published on Thu Nov 06, 2014

Question: For a patient with a nodule in the thyroid gland, the clinical note mentions that our physician performed a fine needle aspiration. When subjected to pathology examination, the pathologist stated that the specimen was inadequate. During the same session, our physician performed a core needle biopsy of the thyroid. Can we report both procedures?

Codify Subscriber

Answer: You may check the clinical report again to ascertain if your physician did the two procedures at the same or different sites on the thyroid. Your physician should document if one procedure was done on the left lobe and another one on the right lobe.

If the procedures are from different sites, you should list the fine needle aspiration (FNA) as 10021 (Fine needle aspiration; without imaging guidance) or 10022 (… with imaging guidance), depending on whether the FNA was an image-guided procedure. For the biopsy, you should list 60100 (Biopsy thyroid, percutaneous core needle).

Check for modifier 59: Because the Correct Coding Initiative (CCI) edits bundle codes 10021 and 60100, you’ll need to append modifier 59 (Distinct procedural service) to the column 2 code, which is the FNA code 10021 or 10022. However, you can override the edit pair only if the procedures are at different sites or sessions. For this you will need your physician to document medical necessity for the procedures.

Watch out: If your physician performed the biopsy at the same site because the FNA sample was inadequate, you should report only the biopsy code 60100. According to Medicare instruction:

“For example, if a fine needle aspiration of the thyroid (CPT® code 10021) is unsuccessful and is followed at the same patient encounter by a percutaneous core needle biopsy of the thyroid (CPT® code 60100), only CPT® code 60100 may be reported. Therefore, CPT® code 10021 is not separately reportable with CPT® code 60100.”

Read more about the Medicare instruction at: www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/ncci_correspondence_language_manual.pdf.

Oncology & Hematology Coding Alert

Biopsies:
Expert Answers to Top Five Questions Ease Your Integumentary Biopsy Reporting
You may lose up to $75 per procedure for any erroneous reporting. Whenever your oncologist [...]

E/M Coding:
Adopt These Practices to Augment Your E/M Coding Skills
Physical examination and physician decisions are key to correct coding. In the last issue of [...]

ICD-10-CM:
Catch Up On Diagnosis Coding For Carcinoma in Situ of Female Genital Tract
Keep documentation for the part of the cervix where the lesion is located. You need [...]

Reader Question:
Describe Side for Malignant Neoplasm of Main Bronchus
Question: What changes can we anticipate for diagnosis coding for malignant bronchial neoplasms? Our physician diagnosed [...]

Reader Question:
Keep Count of Colonoscopy Sessions for Polyp Removal
Question: Our physician did a polyp removal from the colon. In total three polyps were removed [...]

Reader Question:
ABN Applies to Tetanus Vaccines
Question: Can we report for tetanus vaccine in the absence of injury? Will Medicare pay for [...]

You Be the Coder:
Watch for Bundle in Thyroid FNA and Needle Biopsy Coding
Question: For a patient with a nodule in the thyroid gland, the clinical note mentions that [...]

View All