General Surgery Coding Alert

Use modifiers for multiple specimen extractions.

When your general surgeon performs a lung or mediastinum percutaneous needle core biopsy, you should be ready to code the case differently than you did prior to January of this year.

Not only does CPT^® 2021 delete one code and add one code that you need to know, but AMA also introduces new guidelines for how to manage complex cases involving different specimens and/or different imaging methods.

Read on for our experts’ advice about how to code these cases now.

Check Out Code Changes

CPT^® 2021 deletes 32405 (Biopsy, lung or mediastinum, percutaneous needle) and adds 32408 (Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed) in its place.

You should report 32408 once per lesion sampled in a single session. “That means you should not report multiple units of 32408 if the surgeon extracts more than one core needle biopsy from a single lesion during the surgery,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, Calif.

The obvious: The new code includes radiological guidance, when performed, which the deleted code did not. “Previously, the radiology guidance was separately coded,” says Karen Pickering, RHIT, CCS, founder of ReviewMate and Senior Consultant for Pinnacle Enterprise Risk Consulting Services LLC.

In previous years, you would have reported code 32405 with a guidance code such as 77012 (Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation) if the surgeon used CT guidance. You should not report a separate imaging guidance code with the 32408 service, even if the case involves multiple imaging methods to sample a single lesion.

New code 32408 reflects a change that’s happening throughout CPT^® to include the radiology procedures as part of the primary procedure code, rather than billing separately for imaging, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

Here’s why: The CPT^® Editorial Panel by the Relativity Assessment Workgroup (RAW) found that the 32405 service was performed in tandem with imaging guidance more than 75 percent of the time in previous years. The RAW made the executive decision to simplify the process for both coders and payers processing the claims by bundling these services.

Follow New Guidance for Complex Cases

Switching out 32408 for 32405 plus a radiology code isn’t the only change you should expect when coding lung or mediastinum percutaneous needle core biopsies this year. A new guidelines section elucidates the following coding details that you also need to know:

Distinguish specimen type: The new guidance clarifies that a core needle biopsy described by 32408 involves a “needle that is designed to obtain a core sample of tissue for histopathologic evaluation.” In contrast, a fine needle aspiration (FNA) biopsy uses a fine needle to “aspirate” cells for cytologic evaluation. You should report an FNA with the appropriate code from the range 10004-10021 (Fine needle aspiration biopsy …).

Manage multiple specimens: If the surgeon samples multiple lung or mediastinum lesions using core needle biopsy, you can report one unit of 32408 for each separate lesion. Depending on the payer, you may need to report multiple units or append a modifier such as 59 (Distinct procedural service) to the subsequent biopsies. For separate lung or mediastinum lesions biopsied by core needle and FNA on the same day, you should bill 32408 plus the appropriate FNA code with modifier 59.

Distinct imaging: If the surgeon performs a 32408 service and an FNA on a single lesion using the same imaging guidance, you should report codes for both procedures and append modifier 52 (Reduced services) to the lesser service. If the two biopsy methods entail different imaging guidance, however, you should use modifier 59 instead of 52.

If the surgeon performs a 32408 service plus a biopsy of a separate site, such as 47000 (Biopsy of liver, needle; percutaneous), that requires a separate imaging guidance code, you’ll need to append modifier 59 (or similar modifier) to the imaging code, such as 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) to indicate that the imaging code is not for the mediastinum/lung biopsy.