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Doing so requires understanding the 2019 coding changes for reporting these two services during the same session. Effective Jan. 1, 2019, new CPT® codes were introduced to report fine needle aspiration (FNA) biopsies. Proper coding of these procedures starts with an understanding of the new codes, as well as how they affect reporting of core […]
The post How to Be the Best Fine Needle Aspiration and Core Biopsy Coder appeared first on AAPC Knowledge Center.
Any help would be greatly appreciated.:confused:
Patient A
Date:
PREOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the left
upper neck.
POSTOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the
left upper neck.
PROCEDURE: Ultrasound-guided fine-needle aspiration of left neck lymph
node x2.
STAFF SURGEON: M.D.
PROCEDURE: After discussing the procedure with the patient, the left neck was prepped with Betadine prep swab. We then used
ultrasound to examine the left neck region, identified two packets of
lymph nodes, decided to biopsy the lower packet first. I placed a
25-gauge needle into the lymph node packet and aspirated until fluid
was in the hub. I then placed this onto a microscopic slide and spread
it between two different side slides, one was fixed and one was air
dried and I placed the remainder into the CytoLyt solution. I then
changed needle and syringes and aspirated a second higher level lymph
node packet until I got blood return into the hub of the needle.
Again, I placed this on to a slide and spread it between two separate
slides, one was air dried and one was fixed. The remaining solution
was placed into the CytoLyt solution. These were both sent to
pathology. We will await our biopsy results.
_____________________________
M.D.
CC:
PREOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the left
upper neck.
POSTOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the
left upper neck.
PROCEDURE: Ultrasound-guided fine-needle aspiration of left neck lymph
node x2.
STAFF SURGEON:
PROCEDURE: After discussing the procedure with the patient, the left neck was prepped with Betadine prep swab. We then used
ultrasound to examine the left neck region, identified two packets of
lymph nodes, decided to biopsy the lower packet first. I placed a
25-gauge needle into the lymph node packet and aspirated until fluid
was in the hub. I then placed this onto a microscopic slide and spread
it between two different side slides, one was fixed and one was air
dried and I placed the remainder into the CytoLyt solution. I then
changed needle and syringes and aspirated a second higher level lymph
node packet until I got blood return into the hub of the needle.
Again, I placed this on to a slide and spread it between two separate
slides, one was air dried and one was fixed. The remaining solution
was placed into the CytoLyt solution. These were both sent to
pathology. We will await our biopsy results.
Procedure 3 cotton osteotomy right foot medial cuneiform:
Attention was then drawn to the dorsal aspect of the right foot where a 5 cm was generated over the medial cuneiform. Dissection was carried down to the level of the periosteum of the medial cuneiform using a combination of sharp and blunt dissection. Transverse osteotomy was performed, and a metatarsal spreader was used to help relax the soft tissues on the plantar most surface of the medial cuneiform. A Hintermann was introduced to allow for enhanced distraction and a size 6 cotton wedge bone graft was introduced to the medial cuneiform. Prior to doing so, 3 mL of bone marrow aspirate was introduced into the osteotomy site, bathing both the graft as well as the inferior surface. Temporary fixation came in the form of a 0.062 K-wire that was introduced proximal to distal. The wound was irrigated and closed. Prior to doing so, bone putty osteoconductive material was packed around the graft.
Procedure 6 bone marrow aspiration right heel:
Prior to insufflation of the tourniquet, a Jamshidi needle was introduced to the lateral aspect of the body of the tuberosity of the calcaneus. Under negative pressure, 5 mL of bone marrow aspirate was obtained for introduction to both the calcaneal osteotomy as well as the cotton osteotomy site. Once the bone marrow aspirate was obtained, the wound was irrigated and closed in the usual fashion. The patient was then taken to the PACU with neurovascular status intact to the right foot and ankle. The patient tolerated the procedure and the anesthesia well.
There is disagreement in our office as to what the bone marrow aspiration should be coded as:
38220 which the Coder’s Desk Reference says is diagnostic and sent out to be analyzed which he did not do
or
38232 which is more for harvesting for use in an actual transplant
or
0232T PRP which can be by blood or bone marrow but he did not state he spun it down
Any help would be appreciated
Procedure 3 cotton osteotomy right foot medial cuneiform:
Attention was then drawn to the dorsal aspect of the right foot where a 5 cm was generated over the medial cuneiform. Dissection was carried down to the level of the periosteum of the medial cuneiform using a combination of sharp and blunt dissection. Transverse osteotomy was performed, and a metatarsal spreader was used to help relax the soft tissues on the plantar most surface of the medial cuneiform. A Hintermann was introduced to allow for enhanced distraction and a size 6 cotton wedge bone graft was introduced to the medial cuneiform. Prior to doing so, 3 mL of bone marrow aspirate was introduced into the osteotomy site, bathing both the graft as well as the inferior surface. Temporary fixation came in the form of a 0.062 K-wire that was introduced proximal to distal. The wound was irrigated and closed. Prior to doing so, bone putty osteoconductive material was packed around the graft.
Procedure 6 bone marrow aspiration right heel:
Prior to insufflation of the tourniquet, a Jamshidi needle was introduced to the lateral aspect of the body of the tuberosity of the calcaneus. Under negative pressure, 5 mL of bone marrow aspirate was obtained for introduction to both the calcaneal osteotomy as well as the cotton osteotomy site. Once the bone marrow aspirate was obtained, the wound was irrigated and closed in the usual fashion. The patient was then taken to the PACU with neurovascular status intact to the right foot and ankle. The patient tolerated the procedure and the anesthesia well.
There is disagreement in our office as to what the bone marrow aspiration should be coded as:
38220 which the Coder’s Desk Reference says is diagnostic and sent out to be analyzed which he did not do
or
38232 which is more for harvesting for use in an actual transplant
or
0232T PRP which can be by blood or bone marrow but he did not state he spun it down
Any help would be appreciated
Bone marrow aspiration and biopsy codes received updates in CPT® 2018 that significantly change how the services are reported. Existing codes 38220 and 38221 were revised: 38220 Bone Diagnostic bonemarrow; aspirationonly(s) 38221 Bone Diagnostic bonemarrow; biopsy, needle or trocar(ies) Note: To demonstrate the updates for 2018, new text is underlined and deleted text is struck […]
AAPC Knowledge Center
Utilize all the code sets, plus modifiers, to wholly capture physicians’ services. By Dawson Ballard, Jr., CPC, CPC-P, CEMC, CPMA, CRHC, CCS-P Coding for joint arthrocentesis, aspiration, or injection can be difficult, but following a few simple rules and pulling your coding resources together can make it easier. CPT® Categorizes Codes Arthrocentesis, aspiration, or injection […]
AAPC Knowledge Center
During either joint aspiration or injection, imaging guidance may be employed to ensure accurate needle placement. For CPT® 2015, the AMA revised previous joint (or bursa) aspiration/injection codes to specify “without ultrasonic guidance,” while adding codes to describe the same procedures with ultrasonic (US) guidance: 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, […]
AAPC Knowledge Center