Coding for FNAs

We do ultrasound guided FNAs in our office and I need some help making sure I am coding them correctly and using the right modifiers:

Patient with one nodule being biopsied:

E&M code, 25 Modifier
76942,TC
10022,59

What codes do we use when we biopsy another nodule -- same side? different side? Do you have to indicate L and R when billing with the modifier?

When do you use a 76 modifier?

Coding for FNAs

You don't need any modifiers for 10022 when using an ultrasound guidance. Are you doing the professional or technical component? If done in your office, aren't you doing both?

If done at the hospital, aren't you billing the professional component, the interpretation and report?

Use 10022 one time, no matter how many specimens if it is from the SAME nodule.

Use 10022 with 59 modifier if the physician obtains samples from two different nodules.

Use the guidance code for whichever method is used, as per the CPT book.

fluoroscopic (76003), computed tomography (76360), magnetic resonance (76393), or ultrasound (76942)."

Fna

The doctor is doing them in the office, never at the hospital. So with that said, is there something I am missing in my billing? I am a little confused with your response. Isn't the TC the tech component? What would the interpretation code be?

If I am understanding the 2nd part of the reponse correctly, I would bill the 10022 twice with a 59, however would we ever bill the 76942 twice if we obtain samples from two different nodules? Do you have to indicate L or R?

Fna

Sorry -- I sent my question back to you the same time I received your additional response.

Fna

We own the ultrasound machine and the report does not go to radiologists for a read. I will wait to hear back on my last questions.

Fna

For the ultrasound, bill without a modifier. Your physician should dictate that he/she used the ultrasound, take a picture for the record and briefly describe it in the report.

The first nodule is billed with code 10022 with no modifier, the second with the 59 modifier.

I don't know if you bill the 76942 twice: does anyone else on the list know for sure?

Fna

76942 can be coded twice if two lesions biopsied (per CPT Assistant), however Medicare has an MUE in place of 1 unit.

76942

Yes, bill 76942 as indicated for each separate nodule using US guidance.

Coding for FNAs

I don't think I was clear.

Use 10022 without a modifier when sampling one nodule, no matter how many specimens.

Use 10022 for the first, and 10022-59 when second and subsequent nodule are biopsied.

Modifier 76 is when you repeat the procedure after the original procedure/service, so would not be used here.

Select the guidance method. The one you indicated has both a technical and professional component. You indicated modifier TC for technical component. If you own the ultrasound, submit it without a modifier: isn't your physician doing the supervision and interpretation? You would use the TC if you owned the equipment but were sending the film out for a radiologist tot interpret.

Does this help?