tci General Surgery Coding Alert - 2005 Issue 9

Use Caution for Same-Day FNA and PNB

Turn to modifier 59 for aspiration and biopsy at separate locationsIf the patient undergoes a more extensive diagnostic surgical procedure at the same site on the same date of service, Medicare may not pay for an initial fine needle aspiration (FNA). The National Correct Coding Initiative (NCCI) edits bundle FNA with many biopsy procedures under the policy of "sequential procedures." This policy states that when the physician performs a second procedure because the initial procedure did not successfully accomplish a medically necessary service, you should only report the more invasive service.Example: The physician performs a breast lesion...

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