Ask Dr. Z

When a patient is seen for biopsy and "core biopsies" were not possible due to nearby vessels, would it be appropriate to bill biopsy if report calls it such? In this example, the title of report is "Image-Guided Biopsy of 1 cm Left Common Iliac Lymph Node Lesion".

"Using a lateral approach under CT guidance, an 18 gauge needle was advanced down to the lesion of interest. A 22 gauge needle was used to obtain samples for cytologic assessment. The lesion is not amenable to core biopsy because of the close proximity of the arterial vessels and ureter."

Would this be billed as an abdominal biopsy (49180), a lymph node biopsy (38505), or an FNA (10022)? It is titled "Biopsy", yet the report states "core" not collected, rather a needle "biopsy" was. Is this a needle biopsy or an FNA? If it is a biopsy, would "common iliac lymph node" be reported with code 49180 or 38505? It would seem that the work of accessing an area that is deep (such as abdominal or visceral) would be more involved than just an FNA. I would really appreciate your input!