Carol A. Filomena, MD, Government Affairs and Economic Policy Committee

 Test Your Coding Knowledge with this Coding Challenge:

 Procedure:

A 50 year old woman presents to the Pathology Fine Needle Aspiration Biopsy Clinic with bilateral thyroid nodules previously identified by ultrasound. She presents with an order to biopsy a 3 cm right thyroid nodule and a 2.5 cm left thyroid nodule. The patient is examined and both nodules are identified by ultrasound. She is explained the ultrasound-guided fine needle aspiration biopsy procedure including the complications of local bruising, bleeding and possible infection. She signs the consent form. Ultrasound-guided fine needle aspiration biopsy of the right thyroid nodule is performed x 4 and 8 direct smears (4 air-dried and 4 alcohol-fixed) are prepared. The 4 air-dried slides are stained and an immediate assessment of “Adequate” is rendered by the pathologist. Ultrasound-guided fine needle aspiration biopsy of the left thyroid nodule is performed x 4 and 8 direct smears (4 air-dried and 4 alcohol-fixed) are prepared. The 4 air-dried slides are stained and an immediate assessment of “Adequate” is rendered by the pathologist. The remaining alcohol-fixed slides are stained in the laboratory and needle rinses are each prepared as cell blocks. The pathologist renders a final diagnosis.

FINAL DIAGNOSIS:

  1. Thyroid (Right Lobe), Ultrasound-Guided Fine Needle Aspiration Biopsy (direct smears and cell block):

NEGATIVE FOR MALIGNANT CELLS.

Benign thyroid nodule (colloid nodule/nodular goiter) – Bethesda II.

  1. Thyroid (Left Lobe), Ultrasound-Guided Fine Needle Aspiration Biopsy (direct smears and cell block):

NEGATIVE FOR MALIGNANT CELLS.

Benign thyroid nodule (colloid nodule/nodular goiter) – Bethesda II.

Immediate Assessments:

  1. Thyroid (Right Lobe), Ultrasound-Guided Fine Needle Aspiration Biopsy:

Passes 1-4: Adequate.

  1. Thyroid (Left Lobe), Ultrasound-Guided Fine Needle Aspiration Biopsy:

Passes 1-4: Adequate.

Virchow Pathologist, MD

How should this case be coded?

Answer:

10005 – Fine needle aspiration biopsy, including ultrasound guidance; first lesion

10006 – each additional lesion

88172 x 2 – Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site

88173 x 2 – interpretation and report

88305 – cell block x 2

NOTE: The codes 10005 and 10006 are new codes in the AMA CPT 2019 Professional Coding Manual. They replace code 10022, which has been deleted and can no longer be utilized. The code 76942 cannot be reported with these codes.

Code 88172 was reported twice – one time for each rapid interpretation rendered at the time of the procedure. (Each set of 4 air-dried slides were stained for review with one pathologist immediate interpretation for each slide group. If inadequate material was obtained and the pathologist needed to do additional passes, 88177 could be added for each additional rapid interpretation provided.)

References:
-American Medical Association CPT Current Procedural Terminology 2019, professional edition, 2019 AMA.

-Pathology Service Coding Handbook, Version 18.3, American Pathology Foundation, July 1, 2018.