How To Use CPT Code 10005

CPT 10005 is a code for fine needle aspiration biopsy, including ultrasound guidance, for the first lesion. This article will cover the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 10005.

1. What is CPT 10005?

CPT 10005 is a medical billing code used to describe a fine needle aspiration biopsy (FNA) procedure, which includes ultrasound guidance for the first lesion. This diagnostic procedure involves collecting a specimen from tissue, a cyst, or mass using a specialized needle and syringe under ultrasound imaging guidance. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 10005 CPT code description

The official description of CPT code 10005 is: “Fine needle aspiration biopsy, including ultrasound guidance; first lesion.”

3. Procedure

The 10005 procedure involves the following steps:

1. The patient is properly prepared and anesthetized, typically with local anesthesia.
2. Under ultrasound imaging guidance, the provider inserts a needle, such as an 18- to 25-gauge needle with an attached syringe, into a suspicious lesion or area of tissue.
3. The provider withdraws cells, tissue, or fluid for laboratory analysis.
4. Several passes may be made to obtain an adequate specimen.
5. The aspirate is sent to the pathology lab for analysis.

4. Qualifying circumstances

Patients eligible to receive CPT code 10005 services are those who have a suspicious lesion or area of tissue that requires a fine needle aspiration biopsy for diagnostic purposes. The lesion or area of tissue must be accessible using ultrasound guidance, and the patient must be able to tolerate the procedure under local anesthesia. The provider must also have the necessary equipment and expertise to perform the procedure using ultrasound guidance.

5. When to use CPT code 10005

It is appropriate to bill the 10005 CPT code when a fine needle aspiration biopsy is performed using ultrasound guidance for the first lesion. This code should be used for the initial lesion only, and additional codes should be used for any subsequent lesions that are biopsied during the same session.

6. Documentation requirements

To support a claim for CPT 10005, the following information should be documented:

• Indication for the procedure, including the presence of a suspicious lesion or area of tissue that requires biopsy.
• Details of the ultrasound guidance used during the procedure, including images and interpretation.
• Specifics of the needle and syringe used for the biopsy.
• Number of passes made to obtain an adequate specimen.
• Details of the specimen obtained, including its appearance and volume.
• Confirmation that the aspirate was sent to the pathology lab for analysis.
• Any complications or adverse events that occurred during the procedure.

7. Billing guidelines

When billing for CPT code 10005, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 10005 include:

• Report +10006 for each additional lesion in addition to the primary code 10005.
• For FNA of an initial lesion using other types of imaging guidance, see 10007 (fluoroscopy), 10009 (CT), and 10011 (MRI) and +10008, +10010, and +10012 for each additional lesion, respectively.
• If different imaging guidance modalities are used for separate lesions, add modifier 59, Distinct procedural service, to the appropriate primary code.
• For FNA without imaging guidance, report 10021 for the initial lesion and +10004 for each additional lesion.

8. Historical information

CPT 10005 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Similar codes to CPT 10005

Five similar codes to CPT 10005 and how they differentiate are:

• CPT 10006: This code is used for each additional lesion biopsied during the same session using ultrasound guidance.
• CPT 10007: This code is used for the first lesion biopsied using fluoroscopic guidance.
• CPT 10009: This code is used for the first lesion biopsied using computed tomography (CT) guidance.
• CPT 10011: This code is used for the first lesion biopsied using magnetic resonance imaging (MRI) guidance.
• CPT 10021: This code is used for the first lesion biopsied without any imaging guidance.

10. Examples

Here are 10 detailed examples of CPT code 10005 procedures:

1. A patient with a suspicious thyroid nodule undergoes a fine needle aspiration biopsy using ultrasound guidance.
2. A patient with a palpable breast mass undergoes a fine needle aspiration biopsy using ultrasound guidance.
3. A patient with a suspicious lymph node in the neck undergoes a fine needle aspiration biopsy using ultrasound guidance.
4. A patient with a suspicious liver lesion undergoes a fine needle aspiration biopsy using ultrasound guidance.
5. A patient with a suspicious pancreatic mass undergoes a fine needle aspiration biopsy using ultrasound guidance.
6. A patient with a suspicious parotid gland mass undergoes a fine needle aspiration biopsy using ultrasound guidance.
7. A patient with a suspicious axillary lymph node undergoes a fine needle aspiration biopsy using ultrasound guidance.
8. A patient with a suspicious inguinal lymph node undergoes a fine needle aspiration biopsy using ultrasound guidance.
9. A patient with a suspicious lung mass undergoes a fine needle aspiration biopsy using ultrasound guidance.
10. A patient with a suspicious pelvic mass undergoes a fine needle aspiration biopsy using ultrasound guidance.