US Guided Thyroid Biopsy CPT Codes: A Comprehensive Plan

60100 is the primary CPT code for percutaneous core needle biopsy of the thyroid, guided by ultrasound. Additional codes, like 10005 and 10006, cover fine needle aspiration (FNA) under ultrasound guidance, offering specific billing pathways.

Thyroid biopsies are crucial diagnostic procedures performed to investigate palpable nodules or abnormalities detected during imaging studies of the thyroid gland. These biopsies are essential for determining whether a thyroid nodule is benign or malignant, guiding appropriate patient management and treatment strategies. Historically, biopsies were often performed blindly, but advancements in medical imaging, particularly ultrasound technology, have revolutionized the process.

Ultrasound guidance significantly enhances the accuracy and safety of thyroid biopsies. It allows physicians to visualize the nodule in real-time, ensuring precise needle placement and minimizing the risk of complications. The procedure typically involves inserting a fine needle into the thyroid nodule to collect cells for pathological examination. These cells are then analyzed to identify any cancerous or pre-cancerous changes.

Correct CPT coding is paramount for accurate billing and reimbursement of thyroid biopsy procedures. The primary CPT code utilized for ultrasound-guided thyroid biopsies is 60100, representing a percutaneous core needle biopsy. However, depending on the specific technique employed – such as fine needle aspiration (FNA) – additional codes like 10005 or 10006 may be necessary. Understanding these coding nuances is vital for healthcare providers and billing staff.

The Role of Ultrasound Guidance

Ultrasound guidance has become the standard of care for thyroid biopsies, dramatically improving both diagnostic accuracy and patient safety. Prior to ultrasound, biopsies were often performed using palpation, which could lead to inaccurate needle placement and increased risk of non-target sampling. Real-time visualization provided by ultrasound allows for precise targeting of suspicious thyroid nodules, even those that are small or deeply located.

The benefits extend beyond accuracy. Ultrasound guidance minimizes the risk of damaging surrounding structures, such as the recurrent laryngeal nerve or the trachea. It also enables the identification of vascularity within the nodule, which can be a crucial factor in assessing its malignancy risk. This is particularly important when differentiating between benign follicular adenomas and malignant follicular carcinomas.

From a coding perspective, the use of ultrasound is integral to codes like 60100 (core needle biopsy) and 10005/10006 (FNA). The documentation must clearly reflect the ultrasound guidance to support the chosen CPT code and ensure appropriate reimbursement. Without documented ultrasound guidance, billing may be denied or downcoded.

CPT Coding Fundamentals

CPT (Current Procedural Terminology) coding is a standardized medical code set maintained by the American Medical Association. Accurate CPT coding is crucial for proper billing and reimbursement for healthcare services, including US-guided thyroid biopsies. Understanding the nuances of these codes is essential for both providers and billers.

The foundation of accurate coding lies in precise documentation. The procedure report must clearly detail the specific techniques used – percutaneous core needle biopsy versus fine needle aspiration (FNA) – as this dictates the primary CPT code selection. Codes like 60100 represent a specific procedure, and using an incorrect code can lead to claim denials.

Furthermore, understanding code descriptors is vital. The CPT manual provides detailed descriptions of each code, outlining what is included in the procedure. Modifiers, such as 51 (multiple procedures) or 59 (distinct procedural service), may be necessary to accurately reflect the services rendered. Proper application of these modifiers ensures appropriate payment for all work performed during the thyroid biopsy.

Primary CPT Code for US Guided Thyroid Biopsy: 60100

CPT code 60100 stands as the foundational code for billing a percutaneous core needle biopsy of the thyroid, performed under ultrasound guidance. This code specifically encompasses the act of obtaining a tissue sample using a core needle, guided by real-time ultrasound imaging to ensure accuracy and target the appropriate thyroid lesion. It’s the cornerstone for most thyroid biopsy procedures;

The physician fee for 60100, as of today’s date (02/03/2026), is approximately $114.76, with an Ambulatory Payment Classification (APC) payment of $81.20. Facility payments are considerably higher, around $610.01, while non-facility payments are $53.77. These figures highlight the payment variations based on the setting of care.

However, 60100 only covers the core needle biopsy itself. If a fine needle aspiration (FNA) is also performed during the same session, additional CPT codes, such as 10005 or 10006, will be required to accurately reflect the complete scope of services provided and ensure appropriate reimbursement;

Detailed Breakdown of CPT Code 60100

CPT code 60100, “Biopsy thyroid, percutaneous core needle,” details a specific procedure. It involves inserting a core needle through the skin and into the thyroid gland, guided by ultrasound, to extract a tissue sample for pathological examination. This differs from FNA, which uses a smaller gauge needle to aspirate cells.

The procedure necessitates real-time visualization via ultrasound to pinpoint the lesion accurately, minimizing the risk of sampling errors and ensuring diagnostic quality. Proper patient positioning and sterile technique are crucial components. The code inherently includes ultrasound guidance; separate billing for the ultrasound component isn’t typically allowed.

60100’s reimbursement is influenced by factors like geographic location and payer policies. While the national physician fee schedule sets a baseline, local coverage determinations (LCDs) may impose specific requirements. Documentation must clearly demonstrate medical necessity and the specific lesion biopsied.

It’s vital to remember that 60100 doesn’t encompass services like lesion marking or interpretation of pathology results; these require separate coding. Accurate coding of 60100 is essential for appropriate claim submission and avoiding denials.

Percutaneous Core Needle Biopsy Explained

A percutaneous core needle biopsy, as described by CPT code 60100, is a minimally invasive diagnostic procedure. It involves obtaining a tissue sample from the thyroid gland using a relatively large-bore needle inserted through the skin – “percutaneously.” This contrasts with FNA, which uses a smaller needle for cell aspiration.

Ultrasound guidance is integral, allowing precise targeting of suspicious nodules, even those small or deeply situated. The ultrasound visualizes the needle’s path in real-time, enhancing accuracy and safety. Core biopsies yield more tissue than FNAs, providing pathologists with a more comprehensive sample for definitive diagnosis, particularly for differentiating benign from malignant conditions.

The procedure typically requires local anesthesia to minimize discomfort. Multiple core samples may be obtained from different areas of the lesion to account for heterogeneity. Post-biopsy, pressure is applied to the site to prevent hematoma formation.

This technique is crucial in evaluating thyroid nodules, guiding treatment decisions, and ruling out malignancy. Proper technique and documentation are paramount for accurate diagnosis and appropriate billing using code 60100.

ICD-10-CM Diagnosis Codes for Thyroid Biopsy

Selecting the appropriate ICD-10-CM diagnosis code is crucial for accurate claim submission alongside CPT code 60100 (US guided thyroid biopsy). The code should reflect the primary reason for the biopsy, not just the procedure itself. Common codes include those for a “palpable lump or mass of the thyroid gland” (D33.9) or “suspected malignancy of the thyroid” (C73.9).

Specificity is key. If the nodule is known to be suspicious for follicular neoplasm, D33.0 is more appropriate than a general lump code. Codes for thyroiditis (E03.9) may be used if inflammation is the clinical concern. Documentation must support the chosen diagnosis code.

It’s vital to link the diagnosis to the clinical presentation. For instance, if the biopsy is performed due to compressive symptoms, codes indicating those symptoms should be included. Accurate coding ensures appropriate reimbursement and reflects the medical necessity of the procedure.

Reviewing current coding guidelines and payer policies is essential, as specific requirements may vary. Utilizing a comprehensive ICD-10-CM code set alongside 60100 maximizes claim acceptance and minimizes denials.

Common Diagnosis Codes Associated with Thyroid Biopsy

Several ICD-10-CM diagnosis codes frequently accompany CPT code 60100 for US-guided thyroid biopsy. D33.9, representing a “neoplasm of unspecified site of the thyroid gland,” is commonly used for suspicious nodules. E03.9, denoting unspecified hypothyroidism, appears when evaluating thyroid function alongside nodule assessment.

For specific nodule characteristics, D33.0 (follicular neoplasm of thyroid) and D33.1 (papillary neoplasm of thyroid) are crucial when imaging suggests these possibilities. If compressive symptoms are present, codes like R13.11 (lump in neck) or related symptom codes should be added.

C73.9, indicating a malignant neoplasm of the thyroid, unspecified, is utilized when clinical suspicion for cancer is high. Codes relating to family history of thyroid cancer (Z80.79) may also be relevant. Accurate code selection depends on the clinical documentation.

Remember to consider codes for associated conditions like Hashimoto’s thyroiditis (E03.2) if present. Proper diagnosis coding ensures accurate billing and reflects the patient’s specific clinical picture alongside the performed biopsy.

Additional CPT Codes Potentially Used in Conjunction

Beyond 60100, several other CPT codes may be billed alongside a US-guided thyroid biopsy, depending on the services rendered. 10005 and 10006 represent fine needle aspiration (FNA) performed under ultrasound guidance; 10005 is for the initial lesion, while 10006 is for each additional lesion biopsied during the same session.

If fluoroscopic guidance is utilized instead of ultrasound, codes 10007 and 10008 would be appropriate, again differentiated by initial versus additional lesions. Imaging interpretation is often billed separately using codes from the radiology section, depending on the complexity.

Consider 76942 for a magnetic resonance (MR) guided fine needle aspiration. If the procedure is part of a broader diagnostic workup, codes for related consultations or evaluations might also be applicable. Careful attention to documentation is crucial to support the use of these additional codes.

Remember to adhere to coding guidelines regarding bundling and unbundling to ensure appropriate reimbursement. Proper code selection reflects the complete scope of services provided during the patient encounter.

10005: Fine Needle Aspiration (FNA) under Ultrasound Guidance

CPT code 10005 specifically describes fine needle aspiration (FNA) of the thyroid, meticulously guided by real-time ultrasound imaging. This code is utilized when performing a biopsy on the initial thyroid lesion during a single session. It represents a distinct procedural service from the core needle biopsy coded as 60100, focusing on cellular sampling via a smaller gauge needle.

Ultrasound guidance is paramount, enabling precise needle placement within the targeted nodule, minimizing the risk of sampling errors and maximizing diagnostic yield. Accurate documentation detailing the lesion’s location, size, and ultrasound characteristics is essential for justifying the use of 10005.

This code is often used in conjunction with 10006 when multiple lesions are biopsied during the same encounter. Proper coding requires clear differentiation between the initial lesion (10005) and any subsequent lesions (10006). Understanding payer policies regarding bundled or unbundled coding is also vital for successful claim submission.

10006: Image-Guided FNA ⏤ Further Details

CPT code 10006 represents an image-guided fine needle aspiration (FNA), specifically for each additional thyroid lesion biopsied during the same session as the initial lesion coded with 10005. This code acknowledges the incremental work and resources required for each subsequent aspiration, ensuring appropriate reimbursement.

The “image-guided” descriptor emphasizes the continued reliance on ultrasound (or other imaging modalities like CT or fluoroscopy, though less common for thyroid) to accurately target and sample each additional nodule. Detailed documentation is crucial, clearly outlining the number of lesions biopsied and the corresponding use of 10005 for the first lesion and 10006 for each subsequent one.

It’s important to note that 10006 is an add-on code and cannot be billed independently. It’s contingent upon the performance of an initial FNA (10005) during the same encounter. Payers may have specific guidelines regarding the maximum number of lesions billable with 10006, so verifying coverage policies is essential for clean claim submissions.

Modifier Codes Relevant to Thyroid Biopsies

Accurate application of CPT modifiers is vital for precise billing of ultrasound-guided thyroid biopsies. Modifier 51 (Multiple Procedures) is frequently used when multiple biopsies – potentially utilizing codes 60100 alongside 10005/10006 – are performed on different thyroid nodules during the same session. This indicates that the procedures aren’t typically bundled and deserve separate reimbursement.

Modifier 59 (Distinct Procedural Service) is crucial when a procedure isn’t considered an inherent component of another. For example, if a more complex approach or additional time is required for a specific nodule’s biopsy, justifying it as a distinct service using Modifier 59 may be appropriate. Thorough documentation supporting the distinct nature of the service is paramount.

Careful consideration is needed when applying these modifiers. Incorrect usage can lead to claim denials. Understanding payer-specific guidelines and ensuring clear documentation outlining the rationale for modifier application are essential for maximizing appropriate reimbursement and avoiding audit scrutiny. Proper coding reflects the complexity of the procedure.

Modifier 51: Multiple Procedures ⸺ When to Apply

Modifier 51, indicating multiple procedures, is frequently appended to CPT code 60100 (Thyroid Biopsy, Percutaneous Core Needle) when biopsies are performed on more than one distinct thyroid nodule during a single session. This is particularly common as ultrasound often reveals multiple lesions requiring evaluation. Applying Modifier 51 signals to payers that each biopsy represents a separate, identifiable service, warranting individual reimbursement.

However, simply performing multiple punctures isn’t enough. Each nodule must be distinctly identified and documented as a separate lesion. The documentation should clearly delineate the location, size, and characteristics of each nodule biopsied. If the biopsies are considered a bundled service – for instance, very closely clustered nodules treated as a single unit – Modifier 51 shouldn’t be used.

Correct application of Modifier 51 requires careful attention to detail and adherence to payer guidelines. Improper use can lead to claim denials or reduced reimbursement. Always verify payer policies regarding multiple procedure rules and ensure comprehensive documentation supports the need for separate payment for each biopsy performed.

Modifier 59: Distinct Procedural Service ⏤ Specific Scenarios

Modifier 59, denoting a distinct procedural service, becomes relevant in thyroid biopsy coding when CPT code 60100 is reported alongside other potentially bundled procedures during the same encounter; Unlike Modifier 51 (multiple procedures), Modifier 59 signifies that a procedure is not simply an additional component of another, but a separately identifiable service.

A common scenario involves performing an ultrasound-guided thyroid biopsy (60100) and a concurrent ultrasound examination of the thyroid. While the ultrasound guidance is integral to the biopsy, the diagnostic ultrasound itself is a separate service. Applying Modifier 59 to the biopsy code clarifies that it’s not merely an extension of the diagnostic imaging.

Documentation is crucial. Clearly articulate in the medical record why the biopsy is distinct from the ultrasound. For example, if the biopsy targets a specific lesion identified during a separate, focused ultrasound assessment, this supports the use of Modifier 59. Payer guidelines regarding Modifier 59 are stringent; ensure compliance to avoid claim rejections.

Billing and Coding Considerations for Add-on Lesions

When multiple, distinct thyroid lesions require biopsy during a single ultrasound-guided procedure (CPT 60100), billing and coding become complex; The initial biopsy is typically reported with 60100. However, subsequent biopsies of additional lesions require careful consideration to ensure appropriate reimbursement.

The documentation must clearly delineate each lesion biopsied – location, size, and clinical suspicion. While some payers may bundle additional lesions under 60100, others recognize the increased work and may allow separate reimbursement. Codes 10005 or 10006 (FNA under ultrasound guidance) might be applicable for each additional lesion, depending on the technique used.

Always verify specific payer policies regarding add-on lesions. Some require specific documentation or pre-authorization. Accurate coding necessitates a detailed operative report listing each lesion biopsied and the corresponding procedure performed. Failure to adequately document each lesion could lead to claim denials or downcoding, impacting revenue cycle management.

Reimbursement Rates and APC Codes

Reimbursement for ultrasound-guided thyroid biopsy, primarily coded as CPT 60100, varies significantly based on payer, location (facility vs. non-facility), and contract negotiations. As of 02/03/2026, the national physician fee schedule indicates a physician fee of approximately $114.76. However, this is subject to geographic adjustments.

The Ambulatory Payment Classification (APC) code associated with 60100 is 5071, with an ASC payment around $81.20. Facility payments are considerably higher, averaging $610.01, while non-facility payments are around $53.77. These figures represent averages and can fluctuate.

It’s crucial to understand the distinction between facility and non-facility payments. Facility payments apply when the procedure is performed in a hospital outpatient department or ASC, while non-facility payments apply in a physician’s office. Reimbursement can also be affected by modifiers (e.g., 51, 59) used to indicate multiple procedures or distinct services. Regularly reviewing payer updates and coding guidelines is essential for maximizing appropriate reimbursement.

Comparing Facility vs. Non-Facility Payments

The payment landscape for CPT 60100, ultrasound-guided thyroid biopsy, demonstrates a substantial difference between facility and non-facility settings. Facility payments, applicable when performed in a hospital outpatient department or Ambulatory Surgical Center (ASC), generally yield higher reimbursement rates. Current data (as of 02/03/2026) indicates facility payments averaging around $610.01, reflecting the overhead and resources associated with these settings.

Conversely, non-facility payments, utilized when the procedure occurs in a physician’s office, are significantly lower, averaging approximately $53.77. This disparity stems from the differing cost structures; physician offices have lower overhead compared to hospitals or ASCs.

This difference impacts revenue cycle management. Accurate place of service (POS) coding is paramount. Incorrect coding can lead to claim denials or reduced reimbursement. Furthermore, documentation must clearly support the setting in which the procedure was performed. Understanding these distinctions is vital for providers to optimize billing and ensure appropriate compensation for their services, especially considering the APC code 5071 influences these rates.

Documentation Requirements for Accurate Coding

Comprehensive documentation is crucial for accurate CPT coding of ultrasound-guided thyroid biopsies, specifically 60100, 10005, and 10006. The medical record must clearly detail the indication for the biopsy, including relevant clinical findings and prior imaging results. A precise description of the lesion(s) targeted, including size, location, and characteristics, is essential.

Ultrasound reports must be included, demonstrating real-time guidance during the procedure. Documentation should confirm the technique used – percutaneous core needle or fine needle aspiration – and the number of lesions biopsied. If multiple lesions are addressed, proper coding with modifiers like 51 or 59 is vital, supported by detailed lesion descriptions.

Pathology reports are integral, linking the biopsy to the final diagnosis (ICD-10-CM codes). Any complications encountered during the procedure must be documented. Thorough records minimize audit risk and ensure appropriate reimbursement, aligning with Billing and Coding guidelines and Local Coverage Determinations (LCDs).

Common Coding Errors to Avoid

Several coding errors frequently occur when billing for ultrasound-guided thyroid biopsies (CPT codes 60100, 10005, 10006). A common mistake is improper modifier usage; applying Modifier 51 (Multiple Procedures) incorrectly, or failing to use Modifier 59 (Distinct Procedural Service) when appropriate for additional lesions.

Incorrectly bundling or unbundling services is another frequent error. For example, failing to separately report ultrasound guidance when it’s integral to the biopsy. Another issue arises from inadequate documentation supporting the medical necessity of biopsying multiple lesions.

Coders sometimes mistakenly use codes for biopsies guided by other imaging modalities (CT, MRI, Fluoroscopy) instead of the specific ultrasound guidance codes. Failing to link the biopsy to a valid ICD-10-CM diagnosis code also leads to claim denials. Staying current with Billing and Coding articles and LCD updates is crucial to avoid these pitfalls and ensure compliant billing practices.

Updates and Changes in Thyroid Biopsy Coding (as of 02/03/2026)

As of February 3rd, 2026, thyroid biopsy coding remains largely consistent with established guidelines, centering around CPT codes 60100 (core needle biopsy) and 10005/10006 (ultrasound-guided FNA). However, increased scrutiny from payers regarding documentation for multiple lesion biopsies is anticipated.

Recent Billing and Coding articles emphasize the necessity of detailed reporting for each additional lesion biopsied during a single session, justifying the use of appropriate modifiers (59, potentially 51). Payers are increasingly auditing claims to ensure medical necessity and appropriate coding for add-on procedures.

Furthermore, updates to ICD-10-CM codes related to thyroid nodules and neoplasms may require careful review to ensure accurate diagnosis code linkage. Providers should proactively monitor Local Coverage Determinations (LCDs) for any regional variations or specific coverage requirements. Staying informed through professional coding resources and payer updates is vital for compliant billing.