FNA biopsy: 10 things to know about the new codes

With recent significant changes in the fine needle aspiration (FNA) biopsy code family, let’s review a few key takeaways. Prior to this year, there were two CPT® codes describing FNA biopsy: 10021 (fine needle aspiration; without imaging guidance) and 10022 (fine needle aspiration; with imaging guidance).

These codes were fairly straightforward. If an FNA biopsy was performed with imaging guidance, it would be appropriate to report a modality-specific guidance code with 10022. If an FNA biopsy was performed without imaging guidance, it would be appropriate to report 10021 – which would be rare for radiology.

As of January 2019, code 10022 was deleted, code 10021 was revised and nine new codes were introduced for FNA biopsy describing modality-specific imaging guidance. In addition, each type of modality-specific guidance code now has two options:

  • A primary code for the first lesion studied, and
  • • An add-on code for each additional lesion

Here are ten things to know about FNA biopsies and the new codes:

  1. FNA biopsy is the use of a fine needle to aspirate material from an area of interest to be examined cytologically. This is different from a core biopsy, in which a large bore needle is (most often) used to gather a core of tissue to be examined histologically.
  2. There are eight modality-specific FNA biopsy codes – two for each imaging guidance modality:
Imaging Guidance ModalityPrimary Code (First Lesion)Add-On Code (Each Additional Lesion)

Since these codes include imaging guidance, as expressed in their definitions, separately reporting imaging guidance would not be appropriate. Though unlikely to be seen in radiology, there are also two codes for FNA biopsies performed without imagining guidance: 10021 and +10004.

  1. The FNA biopsy codes are not specific to an anatomic site, instead they are specific to the type of imaging guidance used and are reported per lesion studied.
  2. Only a single unit of any primary code may be reported for a single session
  3. It is never appropriate to use more than one unit of the same primary code for the same imaging guidance modality at the same session.
  4. If two lesions are studied at separate anatomic locations during the same session using the same type of imaging guidance, only one of these procedures would be assigned a primary code. The second lesion would be assigned the modality-specific add-on code.
  5. It is possible to assign two primary codes at the same session when two separate lesions are biopsied using two different types of imaging guidance. In this case, each lesion would be assigned the modality specific primary code. Any additional lesions studied using the same type of imaging guidance would be assigned the modality-specific add-on code.
  6. It is never appropriate to assign more than one code at the same session when multiple passes are made, and multiple samples are taken from the same lesion.
  • For example, if three FNA samples were taken from the same lesion using MR guidance, code 10011 would be the only code assigned and it would be assigned only once.
  1. If two samples are taken from two separate lesions using the same type of imaging guidance, the modality-specific primary code would be assigned for one lesion and the modality-specific add-on code for the other. If these same two lesions were aspirated using different types of imaging guidance, then the two modality-specific primary codes would be assigned.
  2. There is a discrepancy between CPT and the NCCI Policy Manual regarding FNA biopsy and core biopsy performed at the same session, on the same lesion, using the same type of imaging guidance.

Per CPT – assign the modality-specific FNA biopsy code and the organ-specific core biopsy code, but do not also assign a separate imaging guidance code used for the core biopsy.

Per the 2019 NCCI narrative instructions, the above guidance would not be correct. Chapter 3, Section L12 instructions were revised for 2019 stating: “12. Fine needle aspiration (FNA) biopsies (CPT codes10004-10012, and 10021) shall not be reported with a biopsy code for the same lesion. For example, an FNA specimen is usually examined for adequacy when the specimen is aspirated. If the specimen is adequate for diagnosis, it is not necessary to obtain an additional biopsy specimen. However, if the specimen is not adequate and another type of biopsy (e.g., needle, open) is subsequently performed at the same patient encounter, the physician shall report only one code, either the biopsy code or the FNA code. (CPT code 10022 was deleted January 1, 2019).”

It is important to be aware of the discrepant guidance and closely monitor payer and NCCI instructions when billing the same type of imaging guidance codes together (i.e., FNA and image-guided core biopsy) to know what is, and what isn’t, appropriate to report.