Medicare Patient: 80 years old
Date of Service: 1-1-16
Clinical Info/Hx: RUL lung mass.
Gross Description: Received are three air-dried smeared slides and three alcohol-fixed smeared slide preparations from a right upper lobe lung mass fine needle aspiration.
Final Microscopic Diagnosis: Non-small cell lung cancer.
What are the appropriate CPT, CPT II, and ICD-10 codes for this scenario?
|Specimen||CPT Code||CPT II Code||ICD10-CM|
Lung – RUL
Fine Needle Aspiration
C34.11 – Malignant neoplasm of upper lobe, right bronchus or lung
Fine Needle Aspiration (FNA) is a listed specimen in CPT as 88173. The 88173 code encompasses all routine FNA slide preparation methodologies; therefore, it would not be appropriate to also assign the 88104 code used to report smeared slide preparations from non-FNA cytology fluids, washings, and brushings specimens.
Medicare made significant changes to the 2016 PQRS eligibility criteria for measure #395 Lung Cancer/ Cytology Reporting by deleting the 88307 code and adding cytology codes 88104, 88108, 88112 and 88173. Also, CMS changed the age requirement from 18-75 years of age on the date of the encounter, to ≥18 years of age on the date of the encounter.
The scenario above meets the eligibility requirements for PQRS measure #395 based on the qualifying CPT and ICD-10 coding combination, and patient age. Therefore, Medicare will place this case in the Denominator (all eligible cases that meet the established PQRS criteria for that measure), and only if a CPT II code is also assigned will Medicare place the case in the Numerator (all cases meeting the eligibility criteria that are also reported with a PQRS CPT II code). The diagnosis of non-small cell lung cancer (NSCLC) is not further classified into the specific histologic type, and there is no documented reason as to why it was not further classified; therefore, the G9421 CPT II code should be assigned.
2016 CPT/CPT II Code Definitions:
Cytopathology, evaluation of fine needle aspirate; interpretation and report
Primary non-small cell lung cancer biopsy and/or cytology specimen report does not document classification into specific histologic type OR classified as NSCLC with an explanation
ICD-10 CM: Malignant neoplasm of lung
Right upper lobe describes the anatomic site of the malignancy and laterality in ICD-10. Alpha Neoplasm table: lung – upper lobe C34.1_. The ICD-10 code is broken down as follows:
- C34 is the primary descriptor of malignant neoplasm of bronchus and lung
- 4th digit of 1 defines the anatomic site of the malignancy as upper lobe
- 5th digit of 1 defines laterality as right