Pathology/Lab Coding Alert

Get paid when pathologists do more than 88173 Your pathologist might perform several steps to complete a fine needle aspiration (FNA) evaluation -- and you'll have to be familiar with codes from surgery (10021) to cytopathology (88172) if you want to capture full payment.

The problem: CPT provides separate codes for FNA procurement (10021-10022), specimen adequacy check (88172), specimen diagnosis (88173), and additional services such as special stains (88312), but the code definitions don't fully define when and how you can report these services for FNA.

The solution: AMA, CMS and specialty societies give direction about how to use these codes, the experts say. 1. Pathologists Can Report Surgical Code for FNA Procurement The pathologist often receives an FNA specimen from another physician who acquired the aspirate from the patient -- but not always. Opportunity: If your pathologist aspirates the lesion to procure the FNA specimen for examination, you should report 10021 (Fine needle aspiration; without imaging guidance) for the service. "The pathologist can report this code even though it is in the surgery section of CPT," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Although CPT provides an alternative FNA procurement code, your pathology practice won't be likely to use 10022 (... with imaging guidance) because it includes imaging guidance, which radiologists, not pathologists, commonly perform.

Hidden Trap: If the patient undergoes a more extensive diagnostic surgical procedure at the same site on the same day, Medicare may not pay for the FNA. That's because the National Correct Coding Initiative (NCCI) edits bundle FNA with many biopsy procedures under the policy of "sequential procedures." This policy states that when the physician performs a second procedure because the initial procedure did not successfully accomplish a medically necessary service, you should only report the CPT code for one procedure, generally the more invasive service.

Example: The physician performs a breast lesion FNA without imaging guidance (10021). Because the FNA results are not conclusive, the physician decides to perform a percutaneous needle core biopsy of the same lesion (19100, Biopsy of breast; percutaneous, needle core, not using imaging guidance [separate procedure]). Because NCCI bundles 10021 with 19100 as sequential procedures, Medicare would pay only for the more extensive procedure that accomplished the diagnostic goal -- 19100.

But that doesn't mean you can never report an FNA (10021) on the same day as a bundled biopsy code. "If the FNA and the biopsy involve different anatomic sites or different patient encounters, you can report both services by appending modifier -59 [Distinct procedural service]," Slagle [...]