I have two cases that involve needle biopsies of soft tissue masses, charging for facility side. The coding pathway leads to codes listed under Excision titles in the CPT book where the parenthetical notes underneath state ( For needle biopsy of soft tissue, use 20206). Here are pertinent excerpts from both reports with the two choices for codes. I’d really appreciate other opinions as to which is correct. I’m tending to lean towards the 20206 in both cases because 20206 specified percutaneous needle while the other codes listed under Excision headings do not specify percutaneous needle. I was told by another coder who is strictly facility that in I-10 PCS coding a biopsy reads out as an excision when any tissue is taken for a diagnostic test.
Case 1:
Under CT guidance, a 19-gauge guide needle was advanced into the soft tissue mass adjacent to the colonic anastomosis. A 25-guage Chiba needle was inserted coaxially through the guide needle and a FNA was obtained. The sample was submitted to the on-site cytopathologist on slides and in formalin. The on-site cytopathologist reviewed the samples and determined that abnormal cells were seen. Then, at the request of the on-site cytopathologist, a 20 gauge core biopsy gun was inserted coaxially through the guide needle and a 20 gauge core biopsy sample was obtained which yielded scant material.
The two choices for this case are 10022, 20206 or 10022, 27041
Case 2:
Patient came today to the IR service for ultrasound guided biopsy of the left popliteal space subcutaneous soft tissue palpable nodule. The left popliteal fossa was prepped and draped in usual sterile fashion. (4) core biopsies were obtained using an 18 gauge Temno core biopsy needle within a coaxial system. The biopsy tissue was placed in formalin and sent tot he lab for cytopathologic evaluation.
The two choices for this case are 27323 or 20206
Thanks very much in advance!