Otolaryngology Coding Alert

Key: Bill FNA for fluid/cell sampling and PNB for tissue collection If you report an otolarynogologist's specimen sampling with a surgery code, you could be miscoding the procedure.

CPT contains specific codes to describe both fine needle aspiration (FNA) and percutaneous needle biopsy (PNB). Distinguishing between these procedures, however, can prove difficult. Here's the lowdown on how you should code each. Aspiration Doesn't Equal Biopsy You must recognize that you should use different codes for FNA and PNB. Unfortunately, your otolaryngologist's notes may make telling what procedure he performed difficult. 

For instance, Carol McGee, a coder at an otolaryngologist's office in Washington asks, "What is the difference between fine needle aspiration biopsy and percutaneous needle biopsy?"

Physicians may use biopsy as a universal term to mean that they took a sample of a specimen. If your otolaryngologist is in this habit, you may miscode his procedures.

Better method: Encourage your physician to reserve biopsy for a biopsy procedure, recommends Pamela J. Biffle, CPC, CCS-P, ACS-DE, approved PMCC instructor, product development director of Custom Coding Books in Bellevue, Wash. That way, you'll know that a chart or operative report that contains the term, "biopsy," really means the physician did a biopsy.

If the otolaryngologist continues to use contradictory language, a few hints will help you tell the terms apart. Procedures Have Own Sections In fact, FNA and PNB are so different that CPT actually contains the procedures in separate sections.

Where to look for FNA codes: "FNA has its own codes which live in the integumentary section, says Tara R. Ritter, CPC, appeals coordinator for American Physician Services, which serves multiple ENT, allergy, sinus and head and neck practices in Atlanta. CPT defines these codes as:

  10021 - Fine needle aspiration; without imaging guidance
  10022 - ... with imaging guidance. How to find PNB codes: Look for the anatomic site-specific surgery code, instructs Ritter.

Example: An otolaryngologists takes a percutaneous biopsy of the salivary gland. When you look in the digestive system under the subheading "salivary gland and ducts," you find 42400 (Biopsy of salivary gland; needle), Ritter points out.
 
Speed tip: To quickly locate an exact PNB code, look up "needle biopsy" in CPT's index. Find the anatomical location the surgeon biopsied, such as the "thyroid gland," and, voila, you have the code: 60100 (Biopsy thyroid; percutaneous core needle).

Editor's note: For a list of PNB codes that otolaryngologists commonly use, see "1 Easy Way to Keep FNA and PNB Straight". Biopsy Involves Larger Needle, Specimen To determine whether you should be using an integumentary system code or an anatomic-specific code, look at two key differences between a FNB and PNB.

1. Consider the needle's size. "A percutaneous needle is much larger than a fine needle," reports Barbara Cobuzzi, [...]