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November-December 2005 Image-Guided Percutaneous Drainage, Aspiration, And Biopsy Procedures: Definitions, Procedural Descr

Introduction: Definitions

Image-guided percutaneous drainage and aspiration procedures provide therapeutic treatment for many types of fluid
collections, including abscess, hematoma, bulla, seroma, and cysts. Drainage treatment is defined as the placement of a
catheter to provide complete or continuous drainage of the fluid collection. Aspiration treatment is defined as evacuation
of a fluid collection or cyst, using either a needle or catheter, with immediate removal of the catheter or needle after the
treatment. 1

Image-guided biopsy procedures provide diagnostic information by obtaining tissue samples percutaneously. These
samples can be obtained by aspiration biopsy or by core biopsy. While any size needle can be used, aspiration biopsy is
usually performed with a fine, thin needle to aspirate a small sample of cells or fluid. Again, while any size needle can be
used, a core biopsy is usually performed with a thicker, larger cutting needle to obtain a core tissue sample rather than
just a few cells. Both aspiration and core biopsies can be performed at the same encounter, taking the two different
types of samples from the same lesion. If both are medically necessary and performed, both procedures may be
separately coded and reported. 2

Image guidance for all of these procedures refers to the use of an imaging modality to identify the exact location of the
area to be treated or sampled. The imaging is also used to ensure that the needle is placed in the correct location to
obtain the biopsy. For most drainage, aspiration, and biopsy procedures, the work and cost of imaging is not included in
the base code and should be reported separately. Biopsy and aspiration guidance can be performed with fluoroscopy,
ultrasound, CT, or MRI (76003, 76942, 76360, 76393). The choice of modality for imaging guidance depends on the site
and characteristics of the fluid collection or lesion. Whatever modality is utilized, documentation of needle or catheter tip
location is necessary.3 In contrast, CPT code 75989 Radiological guidance, ie, fluoroscopy, ultrasound, or computed
tomography for the percutaneous drainage, eg, abscess, specimen collection with placement of catheter, radiological
supervision, and interpretation, describes any or all imaging used to successfully place a catheter to facilitate abscess
drainage. CPT code 75989 should not be reported with other imaging guidance codes for the same procedure.

Biopsies:

Fine needle cytologic and fluid aspiration biopsies are reported using CPT codes, 10021, Fine needle aspiration without
imaging guidance, or 10022, fine needle aspiration with imaging guidance. It is also appropriate to report the imaging
guidance used while performing fluid aspirations. Aspirate samples from these procedures are sent to pathology for
cytologic examination. These are differentiated from core biopsy samples which are sent to pathology for histologic
evaluation. The imaging modality that is used should be reported separately using codes 76003, 76360, 76393, or 76942.
It should be noted that multiple sample passes at the same site or different sites of the same lesion should result in one
biopsy code being reported. 4

Breast: CPT code 19100 is used to report needle core samples taken of a palpable breast lesion when imaging guidance is
not used. Code 19102 refers to an image-guided needle core biopsy, and 19103 refers to the use of an automated
vacuum-assisted biopsy device. All three of the breast biopsy codes were structured based on the biopsy technique used.
When imaging guidance is used for breast biopsy it should be coded with the same modality-specific guidance codes as
for other biopsies. In addition, two guidance codes are available for use only with breast biopsy procedures: 76096 refers
to mammographic guidance, and 76095 refers to stereotactic guidance.

Muscle, soft tissue: Code 20206 is the site-specific code for biopsies of muscle. In CPT, there is no site-specific code for
soft tissue biopsy; however, the CPT book lists, under the open incisional soft tissue biopsy code area, a reference
indicating that the use of 20206 for needle biopsy of soft tissue is appropriate.

Bone, superficial or deep: CPT includes some examples of bone biopsy sites that would be considered superficial (20220)
or deep (20225). These examples generally make the distinction that if the sampled bone is palpable from outside the
body, the code for superficial bone biopsy (20220) should be selected. Nonpalpable bone biopsies are typically performed
using some kind of imaging guidance. The guidance used is then separately reported.

Lymph node: Code 38505 describes a needle biopsy of a lymph node, further defined in CPT as cervical, inguinal, or
axillary lymph nodes. A specific reference is included directing the coder to 49180 for a retroperitoneal lymph node
needle biopsy.

Liver: CPT code 47000 should be used to report a percutaneous needle biopsy of the liver. Imaging guidance for this
procedure is reported by 76003, 76360, 76393 or 76942. If a needle biopsy of the liver is performed at the time of
another major procedure, 47001 is the appropriate code to use.

Transcatheter Biopsies: Also of note in the coding of biopsy procedures is the transcatheter biopsy. This procedure is
reported using CPT code 37200, which describes obtaining a biopsy specimen through a vascular catheter. Coding for the
catheter placement should be reported separately, as it is not included in 37200. The corresponding radiological
supervision and interpretation (RS&I) code for 37200 is 75970.

Site-specific Biopsy Codes for Core Needle Biopsy - Table 1

Breast 19100 Biopsy of breast; percutaneous, needle core, not using

imaging guidance (separate procedure)

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