2025 CPT code 32096
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Respiratory System Surgery Feed
Thoracotomy with diagnostic biopsy(ies) of lung infiltrate(s) (e.g., wedge, incisional), unilateral.
Modifiers 50 (bilateral procedure), 59 (distinct procedural service), and others may be applicable depending on the circumstances of the procedure.
Medical necessity for code 32096 is established when there is a clinical indication for a lung biopsy to diagnose a suspected lung pathology (e.g., tumor, infection, inflammatory process).The results of the biopsy are necessary to guide further treatment.
The surgical team is responsible for all aspects of the procedure, including anesthesia, incision, biopsy acquisition, specimen handling, and wound closure. Post-operative care is also the responsibility of the surgical team.
In simple words: The doctor makes an opening in the chest wall to take samples of abnormal tissue in the lung to find out what is causing the problem.This may involve removing fluid if necessary.
This procedure involves a thoracotomy (open surgical incision into the chest) to obtain diagnostic biopsy specimens from lung infiltrates.The biopsies may be wedge or incisional, and multiple biopsies from a single lung or from both lungs may be taken. Excess fluid may be drained if pleural effusion is present. The specimens are sent for pathological examination.The wound is closed, and chest tubes may be placed for drainage.
Example 1: A 60-year-old male presents with a suspicious lung nodule detected on CT scan. A thoracotomy with wedge biopsy of the nodule is performed using code 32096 to obtain tissue for diagnosis., A 72-year-old female with a history of lung cancer presents with new lung infiltrates.A thoracotomy with multiple incisional biopsies from the infiltrates is performed using code 32096 to determine the nature of the infiltrates. Pleural fluid is also drained., A 55-year-old male presents with symptoms suggestive of an infectious lung process. A thoracotomy with wedge biopsy is performed from both lungs to sample and differentiate various areas of infiltrate.Code 32096 is reported separately for each lung, with appropriate modifier for bilateral services.
* Preoperative diagnostic imaging (e.g., CT scan, X-ray) showing the location of the lung infiltrate(s).* Operative report detailing the approach (thoracotomy), technique (wedge or incisional biopsy), number and location of biopsies, and any fluid drainage.* Pathology report describing the results of the biopsy.* Anesthesia records.
** Thorough documentation is crucial for accurate coding and reimbursement.Clarify any ambiguities with the payer if necessary.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Thoracic Surgery, Pulmonary Medicine
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center