Fine Tune Your Thyroid FNA Claims

By Susan Dooley

Are you reporting a fine needle aspiration procedure (FNA) of the thyroid? If the documentation clearly
specifies fine needle aspiration, you can choose from two CPT code options to report this procedure:

10021, Fine needle aspiration; without imaging guidance

10022, Fine needle aspiration; with imaging guidance.

Fine needle aspiration is a procedure that aspirates, or sucks out, a small amount of cells or fluid
collected from a cyst, mass, or nodule. FNA is performed with a very fine needle, usually from about 18
to 25 gauge, along with a syringe. Needles used for FNA are very thin, with a smaller diameter gauge, or
opening, than regular needles. The higher the number of the gauge, the finer or smaller the inner and
outer diameter of the needle; a 25 gauge needle has a smaller diameter than an 18 gauge. (Sutures are
similarly numbered; a 7-0 suture is much finer than a 2-0 suture.)
FNA of the thyroid is frequently, though not always, performed with ultrasound guidance to ensure that
the needle is positioned in the correct area, such as in a suspicious thyroid nodule.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Watch Your Image(ing)!

When you report 10022, dont forget to also report an appropriate imaging code, such as:

76942, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization
device), imaging supervision and interpretation

77002, Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization
device).

How many units of the imaging can you report? For Medicare, just one per encounter. Pull out the 2016
NCCI Manual, and turn to Chapter 9. It tells us this: CPT codes 76942, 77002, 77003, 77012, and 77021
describe radiologic guidance for needle placement by different modalities. CMS payment policy allows
one unit of service for any of these codes at a single patient encounter regardless of the number of
needle placements performed. The unit of service for these codes is the patient encounter, not number
of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.
Heres a nice bonus tip for 76942: CPT Assistant (March 2011) tells us that to report 76942, your
provider doesnt have to use the ultrasound guidance to guide the needles actual insertion through the
skin. As long as the ultrasound imaging guides where your provider places the needle, you can report
this code with 10022.

Check Your Units for Fine Needle Aspiration

How many times on the same day of service can you report an FNA code, you wonder? In chapter 3,
page 12, of the 2016 NCCI Manual, we discover this: The unit of service for fine needle aspiration (CPT
codes 10021 and 10022) is the separately identifiable lesion. If a physician performs multiple passes
into the same lesion to obtain multiple specimens, only one unit of service may be reported. However, a
separate unit of service may be reported for separate aspiration(s) of a distinct separately identifiable
lesion.
So there you have it all you have to do is count the separate lesions in the procedure report. If your
provider uses ultrasound guidance to perform FNA on two separate lesions in the right lobe of the
thyroid and on one separate lesion in the left lobe, then you would report three units of 10022.

How About You?

Does your provider perform image-guided FNAs? Got any tips for us? Write to us.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

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Direct: 704 303 8150

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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com