2025 CPT code 32604
Effective Date: N/A Surgery - Surgical Procedures on the Respiratory System Feed
Thoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy.
Modifiers may be applicable to this code, such as -22 (Increased Procedural Services) if the procedure is significantly more complex than usual.
Medical necessity must be established by documenting the clinical indication for the procedure, such as abnormal imaging, symptoms suggestive of pericardial disease, or the need for tissue diagnosis.
The physician prepares the patient, administers anesthesia, makes the incision, inserts the thoracoscope, examines the thorax, obtains the biopsy, may place chest drains, and closes the incisions.
In simple words: The doctor inserts a small camera through a small cut in your chest to examine the sac around your heart and take a tissue sample for analysis.
This code describes a diagnostic thoracoscopy procedure specifically targeting the pericardial sac and involving a biopsy.A thoracoscope, a thin, flexible tube with a light and a small video camera, is inserted through a small incision to visualize and obtain a tissue sample from the pericardium.
Example 1: A patient presents with an abnormal chest x-ray showing fluid around the heart. A diagnostic thoracoscopy with pericardial biopsy (32604) is performed to evaluate for infection or malignancy., A patient with a history of heart surgery experiences chest pain and shortness of breath.A diagnostic thoracoscopy with pericardial biopsy (32604) is performed to assess for constrictive pericarditis., A patient with a suspected pericardial cyst undergoes a diagnostic thoracoscopy with pericardial biopsy (32604) to confirm the diagnosis and obtain a tissue sample.
Documentation should include operative report detailing the thoracoscopic procedure, biopsy location, findings, and any associated procedures. Preoperative imaging and pathology reports should also be included.
- Revenue Code: P8I - ENDOSCOPY - OTHER
- Specialties:Thoracic Surgery, Pulmonary Medicine, Cardiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center