CPT Code and Description
10009 – Fine Needle Aspiration Biopsy, Including Ct Guidance; First Lesion.
10010 – Fine Needle Aspiration Biopsy, Including Ct Guidance; Each Additional Lesion (List Separately In Addition To Code For Primary Procedure).
10021 – Fine Needle Aspiration Biopsy, Without Imaging Guidance; First Lesion.
Fee amount from Top Insurance:
| Insurance Name | 10009 | 10010 | 10021 |
| Medicare | $397.25 | $219.02 | $94.39 |
| Aetna | $317 | $219 | $83 |
| Blue Cross Blue Shield | $396 | $207 | $70 |
| Cigna | $327 | $225 | $83 |
| Humana | $385 | $202 | $67 |
| UnitedHealthcare | $417 | $219 | $83 |
FINE NEEDLE ASPIRATION
Documentation Requirements:
▪ Signed order
▪ Patient consent
▪ Identify the location of each lesion treated
▪ Provide a complete description of each lesion treated
▪ When guidance is used, identify the modality (e.g., ultrasound, fluoroscopic, CT, MR) for every lesion treated
▪ Medical necessity must be documented for every lesion treated
▪ Outcome of the procedure
Coding Tips:
In 2019, CPT, along with the 2019 NCCI Coding Manual, provided clear-cut information as to how to codeFNA biopsies vs. core needle biopsies. CPT defines fine needle aspiration (FNA) biopsies as well as core needle biopsy as follows:
▪ Fine needle aspiration (FNA) biopsy is performed when material is aspirated with a fine needle and the cells are examined cytologically
▪ Core needle biopsy is typically performed with a larger bore needle to obtain core sample of tissue for
histopathologic evaluation
New CPT guidelines for FNA biopsy:
▪ Imaging guidance codes can no longer be assigned along with FNA procedures
▪ When more than one FNA biopsy is performed at separate lesions, same session, same day, same imaging
modality, use the appropriate imaging modality add-on code for the second and subsequent lesion(s)
▪ When more than one FNA biopsy is performed on separate lesions, same session, same day, using different
imaging modalities report the corresponding primary code with modifier 59 for each additional imaging modality and corresponding add-on codes for subsequent lesions sampled
▪ This instruction applies regardless of whether the lesions are ipsilateral or contralateral to each other,
and/or whether they are in the same or different organ/structures
▪ When FNA biopsy and core needle biopsy both are performed on the same lesion, same session, same day using the same type of imaging guidance, do not separately report the imaging guidance for the core needle biopsy
▪ When FNA biopsy is performed on one lesion and core needle biopsy is performed on a separate lesion, same session, same day using the same type of imaging guidance, both the core needle biopsy and the imaging guidance for the core needle biopsy may be reported separately with modifier 59
▪ When FNA biopsy is performed on one lesion and core needle biopsy is performed on a separate lesion, same session, same day using different types of imaging guidance, both the core needle biopsy and the imaging guidance for the core needle biopsy may be reported with modifier 59
Surgical Assistants
The first assistant in a surgical operation should be a trained individual who is able to
participate in and actively assist the surgeon in completing the operation safely and
expeditiously by helping to provide exposure, maintain hemostasis, and serve other technical
functions. The qualifications of the person in this role may vary with the nature of the
operation, the surgical specialty, and the type of hospital or ambulatory surgical facility.
The American College of Surgeons supports the concept that, ideally, the first assistant at
the operating table should be a qualified surgeon or a resident in an approved surgical
training program. Residents who have appropriate levels of training should be provided with
opportunities to assist and participate in operations. If such assistants are unavailable, other
physicians who are experienced in assisting may participate.
It may be necessary to have nonphysicians serve as first assistants. Surgeon assistants (SAs)
or physician assistants (PAs) with additional surgical training should meet national
standards and be credentialed by the appropriate local authority. These individuals are not
authorized to operate independently. Formal application for appointment to a hospital as a
SA or PA should include the following qualifications and credentials:
- Specification of which surgeon the applicant will assist and what duties that will be
performed. - Indication of which surgeon will be responsible for the supervision and performance
of the SA or PA. - Review and approval of the application by the hospital board.
- Registered nurses with specialized training may function as first assistants. If such a
situation should occur, the size of the operating room team should not be reduced;
the nurse assistant should not simultaneously function as the scrub nurse and
instrument nurse when serving as the first assistant. Nurse assistant practice
privileges should be granted based upon the hospital board’s review and approval of
credentials. Registered nurses who act as first assistants must not have responsibility
beyond the level defined in their state nursing practice act.
Surgeons are encouraged to participate in the training of allied health personnel. Such
individuals perform their duties under the supervision of the surgeon.
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