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FNA billing/coding

  1. #1
    Smile FNA billing/coding
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    The procedure is performed by an endo/internal medicine doc at the local hospital which she has priviledges at. The practice is owned by the physicians and NOT hospital owned.

    I have come up with the following coding: 76942, 10222 & 88172. Thanks to all who can offer your own experience in coding for these procedures.

    :>)

  2. #2
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by coding4fun View Post
    The procedure is performed by an endo/internal medicine doc at the local hospital which she has priviledges at. The practice is owned by the physicians and NOT hospital owned.

    I have come up with the following coding: 76942, 10222 & 88172. Thanks to all who can offer your own experience in coding for these procedures.

    :>)
    FNA with imaging guidance is 10022
    Imaging is 76942-26 if done at the hospital since hospital would own the equipment, 76942 if global (physician owns equipment, done in office)
    The cytopathology is 88172 if endo doc is looking at it him/herself.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Default
    sorry for the typo on the 10022. I do bill as you mentioned but the insurance carrier(s) are not paying very well and I just wanted to make sure that there was not another way to bill for this procedure. The ins carrier in question is Anthem (they pay a nominally with a cont adj being triple the pymt amt). Thanks for your help!

  4. #4
    Location
    Midtown Oklahoma City
    Posts
    79
    Default FNA Path code
    88172 is for FNA adequacy check. 88172 is for FNA. Modifier 26 on both for interp.

  5. #5
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by coding4fun View Post
    sorry for the typo on the 10022. I do bill as you mentioned but the insurance carrier(s) are not paying very well and I just wanted to make sure that there was not another way to bill for this procedure. The ins carrier in question is Anthem (they pay a nominally with a cont adj being triple the pymt amt). Thanks for your help!
    Are they perhaps only allowing Medicare's allowance? National is only $82.23 for 10022 in the facility, and not really that much more in the office. If they are allowing less than that, I would take a look at the contract and the fee schedule that the office agreed to.

    Hope this helps!
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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