Basics of Fine Needle aspiration CPT code 10021

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 code used for fine needle aspiration is 10021 (CPT code 10022 is deleted in 2019). This CPT code is used only when a Fine Needle Aspiration procedure 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.

Pr0cedure Performed for FNA CPT code 10021

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 The vacuum is released and the needle is withdrawn from the tissue.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. In 2019, we have the bundled CPT codes for Fine Needle aspiration  along with imaging guidance, which we learn later in this article. 

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. 

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CPT codes description for  FNA from 2019

CPT 10021 and 10022 (deleted in 2019) are only used for Fine Needle aspiration coding. Procedure code 10021 is coded when a FNA is performed without guidance. In 2019, we are having bundled CPT codes for FNA with imaging guidance. Below I am sharing the new list of new CPT codes for Fine needle aspiration, which will include ultrasound (code 76942), fluoroscopic (code 77002), CT (code 77012), MRI (code 77021) guidance. 

• 10021 (Revised) – Fine needle aspiration biopsy, without imaging guidance; first lesion.
• 10022 (Deleted) – Fine need aspiration with imaging guidance
• 10004 (New) – Fine needle aspiration biopsy, without imaging guidance; each additional lesion
• 10005 (New) – Fine needle aspiration biopsy, including ultrasound guidance; first lesion
• 10006 (New) – Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion
• 10007 (New) – Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
• 10008 (New) – Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion
• 10009 (New) – Fine needle aspiration biopsy, including CT guidance; first lesion
• 10010 (New) – Fine needle aspiration biopsy, including CT guidance; each additional lesion
• 10011 (New) – Fine needle aspiration biopsy, including MR guidance; first lesion
• 10012 (New) – Fine needle aspiration biopsy, including MR guidance; each additional lesion

Do not report 10004, 10021 in conjunction with 10005, 10006, 10007, 10008, 10009, 10010, 10011, 10012 for the same lesion

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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 (32408) , 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 10021 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.

References:

http://blog.supercoder.com/cpt-codes-2/

https://codapedia.com/topicOpen.cfm