Basics about Fine Needle aspiration CPT codes
Fine needle aspiration (FNA) is a percutaneous procedure performed with the use of fine gauge needle (mostly around 22 to 25 gauge). A syringe is also used to remove the sample fluid from the cyst or to remove clusters of cells from a solid mass. FNA procedure codes are not site specific. For core biopsy we have different procedure codes for percutaneous lung biopsy or thyroid biopsy. CPT codes used for fine needle aspiration includes only two procedures codes, CPT 10021 and 10022. These two CPT codes are used only when a Fine Needle Aspiration procedures is performed. Along with FNA we also have to code imaging guidance procedure codes, when performed. Imaging guidance CPT codes are add-on codes and should be reported along with major primary procedure code.
Initially, the skin is cleansed. A standard (22-25 gauge) needle attached to a syringe or an aspiration pistol is pushed through the skin in a single firm movement. When the tip of the needle enters the suspect mass the barrel of the syringe is pulled and a vacuum is created: the needle is then passed through the tumor one or more times. (Cells are aspirated into the syringe.) The vacuum is released and the needle is withdrawn from the tissue. Firm pressure is applied to the puncture site to minimize hematoma formation.Different imaging guidance like fluoroscopy, ultrasound or computed tomography (CT) is used for performing FNA. Fluoroscopy helps in guiding the correct advancement of needle to the area under examination. Ultrasound guidance CPT 76942 helps in insertion of an aspiration catheter needle through the accessory channel port of the endoscope. The needle is finally placed in the area to be sampled under endoscopic ultrasound guidance. CT guidance helps in allowing computer-assisted targeting of the area to be sampled. FNA is performed on non-palpable lump. The needle in inserted to the area to be sampled and the sample is aspirated under guidance. Once the procedure is done, the needle is removed and as small bandage is applied over the area.
CPT codes description of FNA
CPT 10021 and 10022 are only used for Fine Needle aspiration coding. Procedure code 10021 is coded when a FNA is performed without guidance, while CPT code 10022 is used for FNA performed with guidance. The imaging guidance CPT codes are followed with 10022 CPT code only. Use 76942, 77002, 77012 & 77021 imaging guidance as add-on code when performed with Fine Needle aspiration procedures.
10021 FNA; without imaging guidance
10022 FNA; with imaging guidance.
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Do and Don’t of CPT code for Fine Needle Aspiration
Do not use FNA CPT codes for percutaneous Needle biopsy for breast. Use 19081-19086 CPT codes for these procedures.
Do not use FNA CPT Codes when core biopsy is done. We have separate procedure code for percutaneous needle biopsy for Muscle (CPT code 20206), Pleura (CPT code 32400), Lung or mediastinum (32405), liver (CPT code 47000), salivary gland ( CPT code 42400), pancreas (CPT code 48102), abdominal or retroperitoneal mass (CPT code 49180), Kidney (CPT code 50200), testis (CPT code 54500), epididymis (CPT code 54800), Thyroid (CPT code 60100), spinal cord (CPT code 62269).
Do not use 10221 or 10221 for breast cyst aspiration. We have separate CPT codes 19000-19001 for single or multiple breast cyst aspiration.
For evaluation of Fine needle aspirate for immediate cytohistologic study we have separate CPT code 88172 and 88173. CPT 88172 is used for first evaluation episode of each site and CPT 88173 is used for final interpretation and report for each anatomic site regardless of the number of evaluation episodes or needle passes performed during the FNA procedure.