FNA Biopsy Coding Guidelines

Overview

This lecture explains CPT coding guidelines for fine needle aspiration (FNA) biopsies, including code selection, use of guidance modalities, and proper application of modifier 59.

Types of Biopsies

• FNA uses a thin hollow needle to remove cells or fluid; codes 10004–10012, 10021.
• Core needle biopsy removes cylindrical tissue samples; coded by body area.
• Excisional biopsy removes entire tumors with margins; coded by body area.
• Incisional biopsy removes a small part of a large tumor; coded by body area.

Coding FNA Biopsies

• FNA biopsy codes are selected by guidance type, not by tissue location.
• Main guidance types: No guidance, ultrasound, fluoroscopy, CT, MRI (each has a specific primary code).
• Add-on codes apply for each additional lesion biopsied in the same session with the same guidance.

Use of Modifier 59

• Modifier 59 indicates distinct procedural services, such as different lesions or modalities in the same session.
• Use when procedures are performed on different sites, during different sessions, or with different guidance.

Coding Multiple Lesions and Modalities

• If multiple lesions use the same guidance, use one primary code and add-on codes for each additional lesion.
• If different guidance modalities are used, report a primary code for each modality with modifier 59 on the second code.
• Do not use additional radiology guidance codes for FNA biopsies as they are included.

FNA and Core Needle Biopsies in One Session

• If performed on the same lesion, report both the FNA and core needle biopsy codes; do not separately code guidance for the core biopsy.
• If different lesions, report both codes with modifier 59 on the core biopsy and, if needed, on the guidance code for the core biopsy.

Summary of Guidelines

• FNA, different lesions, same modality: primary and add-on code(s).
• FNA, different lesions, different modalities: primary codes for each, modifier 59 on subsequent codes.
• FNA + core biopsy, same lesion, same modality: report both, do not code imaging separately.
• FNA + core biopsy, different lesions, same modality: report both; modifier 59 on core biopsy and guidance.
• FNA + core biopsy, different lesions, different modalities: report both; modifier 59 on core biopsy and imaging.

Key Terms & Definitions

• FNA (Fine Needle Aspiration) Biopsy — Biopsy using a thin needle to extract fluid/cells.
• Core Needle Biopsy — Biopsy using a larger hollow needle to extract cylindrical tissue.
• Modifier 59 — CPT modifier indicating a distinct procedural service.
• Modality — Type of imaging guidance used during biopsy (e.g., ultrasound, CT, MRI).
• Add-on code — Extra code used to report each additional lesion biopsied during same session.

Action Items / Next Steps

• Write guiding questions and summary notes in your CPT book for FNA coding.
• In the CPT index, add a note by "biopsy" to "see also: fine needle aspiration biopsy."
• Review CPT guidelines for fine needle aspiration biopsy codes and associated modifiers.