FNA of Thyroid vrs Thyroid Biopsy

NESmith

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I have an Endrocrinologist who is performing a FNA of the Thyroid with Unltrasound Guidance. He states in his report that with Ultrasound guidance, 2 passes were made with a 25g needle. To assure adequace the last pass was made using a 18g/core needle. He sent the aspiration as direct smears in alcohol. He is billing this as a 10022-59 & 60100. I was under the understanding that a biopsy would be sent in a speciman jar in formalin and done as a gross examination. The reports would also be different as one would be a cytology report and the other a histology. Please help me with this. Thanks
 

NESmith

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As always, Thank You for your help in this matter. But, as usual I have two other questions. please explain to me the difference between a FNA & PNB. And, when you would you billed the CPT code 10022 or 60100?
 
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I'm looking at this from the pathology side of the house so these surgical codes don't mean to much to me even though I understand the principal.

The best way to think about an aspiration biopsy is that it is fluid, regardless of the gauge of the needle (whether it is "fine" or not). Only fluid and random cells are submitted to cytology. In a Prostate Needle Biopsy (PNB) actual tissue is extracted for pathological diagnosis. That specimen goes to a surgical pathologist rather than to a cytopathologist.

Your surgeon may be using a big needle but if he or she isn't taking tissue to send to the lab, they aren't doing a tissue biopsy which is what the 60100 code is meant to describe.

I hope this is clear and correct. FNA's are tricky things. If he really wants to make sure the specimen is adequate he would get a rapid consult during the procedure. This is a question of technique and method on the surgeon's part. The end result is the same and the codes are clear on what is accurate.

Best,
WK
pathcoder.blogspot.com
 
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