Otolaryngology Coding Alert

Question: An otolaryngologist performs fine needle aspiration (FNA) of a peritonsillar abscess. Codes 42700 and 10160 seem inappropriate. Does a better choice exist?


Massachusetts Subscriber
Answer: Absolutely. CPT actually contains specific FNA codes:
  10021 - Fine needle aspiration; without imaging guidance
  10022 - ... with imaging guidance. Since you don't mention whether the otolaryngologist used imaging guidance with the FNA, you should report 10021. If the surgeon performs FNA and imaging guidance, you should report 10022 and the appropriate guidance code, as follows:  Fluoroscopy - 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device])
  CAT scan - 76360 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation)
  MRI - 76393 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation)
  Ultrasound - 76942. The codes you mention describe procedures for drainage, rather than sampling. Code 42700 (Incision and drainage abscess; peritonsillar) is a surgical procedure in which the otolaryngologist makes an incision in the abscess to drain it. In 10160 (Puncture aspiration of abscess, hematoma, bulla or cyst), the surgeon introduces a large syringe into an abscess, hematoma, bulla or cyst to drain fluid.

In contrast, an otolaryngologist performs FNA to remove fluid for pathologic analysis using a very fine needle.