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Basics of Percutaneous Lung Biopsy Cpt code

In interventional radiology, we have many CPT codes for Biopsy procedures. Breast biopsy has the most number of CPT codes to code in Percutaneous surgery. Now, as we know biopsy procedure are done to take sample of particular organ and study it to find any abnormal finding in them.

Like breast biopsy, we examine breast mass or lesion to see whether it is malignant or benign for breast cancer, similarly lung biopsy is done to examine the abnormal lung mass or nodule present in lung, whether is malignant or benign in nature. I have also shared about the thyroid biopsy coding.

Biopsy procedure is very effective in finding the initial stages of cancer, so that it can be treated on right time. Now, let check out the CPT codes used for coding Lung Biopsy in minimal non-invasive procedures.

If you are a surgery coder, you should know all the guidance CPT codes used along with the biopsy procedures. Now, most of the CPT codes inlcudes the guidance or supervision & interpretation codes. Even the breast biopsy procedure were updated before including the guidance services included with the main procedure code. But, other biopsy procedure still needs guidance codes.

So, the most commonly used code used for biopsy is Ultrasound guidance, CPT code 76942. One needs to always remember it should be coded only with non-vascular procedures in surgery coding. For Vascular procedure, we have separate CPT code 76937 for vascular procedures. Same goes for Fluoroscopic guidance, 77001 should be coded with vascular procedures and 77002 for non-vascular procedures like biopsy and injection procedures like arthrogram, arthrocentesis etc.

Percutaneous Lung Biopsy Cpt codes

For the main procedure for lung biopsy done in lung or mediastinum using percutaneous needle we use to code 32405 code(Deleted in 2021) . While the guidance used with this procedure is 77012, CT guidance for biopsy procedures.

So, we usually have to two CPT codes for lung biopsy, one for main procedure and the other for the guidance used to obtain the sample like the mass, nodule or lesion from the lung.

For CT Lung Biopsy, a new code has been added in 2021 that bundles imaging guidance. Existing code 32405 has been deleted.

32405 Biopsy, lung or mediastinum, percutaneous needle (Deleted in 2021)

32408 Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed

Do and Don’t with Percutaneous Lung Biopsy Cpt code

Do not code and open biopsy procedure code for percutaneous lung biopsy. If an open biopsy is done, they will never use guidance because in open procedure they will just cut and open the body through incision, which is a not done in percutaneous procedure. In percutaneous biopsy, the physician will only use a needle and will not cut any part of skin; he or she will just pass a needle through the skin using guidance and perform the minimal invasive procedure.

For open biopsy of lung, use CPT code 32096, 32097.

Do code the correct guidance code used while performing lung biopsy. Sometimes, the ultrasound guidance 76942 is also used in place of CT guidance 77012.

EBUS and Bronchosocpy CPT codes

There are many procedure code used for coding biopsy of lung region. Combined CPT codes of biopsy with bronchoscopy and endobronchial ultrasound (EBUS) are used for coding surgery procedure.

Endobronchial ultrasound (EBUS) is a minimally invasive technique utilizing ultrasound in conjunction with bronchoscopy to view the airway wall and adjacent structures. Utilizing appropriate anesthesia, the physician performs a transbronchial needle aspiration (TBNA) biopsy on lymph nodes via a thin flexible instrument (bronchoscope) fitted with an ultrasound processor, as well as a fine-gauge aspiration needle guided through the patient’s mouth and trachea permitting real-time imaging of the airways, blood vessels, lungs, and lymph nodes. The physician can view hard to reach areas and gain greater access to biopsy smaller lymph nodes than would be possible via conventional mediastinoscopy.

A pathologist in the operating room with the physician can immediately process the biopsy samples and/or request additional samples as necessary, leading to a quicker diagnosis of cancer, infections, or other inflammatory diseases of the lungs, as well as to assist in staging lung cancer. There are two types of EBUS: radial probe EBUS and linear probe EBUS. The radial probe EBUS has a rotating mechanical transducer with very good image quality that permits the airway layers to be identified but TBNA is not possible with this device. The linear probe EBUS is a fixed array of electronic transducer aligned in a curvilinear pattern and permits real-time guidance for mediastinal lesion sampling.

EBUS procedures may be performed under general anesthesia or with moderate conscious sedation and typically allow for patients to go home the same day as the procedure. CPT code 31652 is reported for EBUS-guided biopsy for one or two mediastinal and/or hilar lymph node stations or structures and 31653 for three or more. CPT code 31654 is reported when EBUS using a radial ultrasound probe is performed during diagnostic or therapeutic bronchoscopy for peripheral lesions.

In 2016, the American Medical Association (AMA) created three new Current Procedural Terminology (CPT) codes for reporting endobronchial ultrasound-guided procedures.

31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures

31653 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures

+31654 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic interventions(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s])

31623 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings

31625 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites

31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe

31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)

+31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)

+31633 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure)

Do remember :

CPT codes 31628 and 31632 should be reported only once, regardless of how many transbronchial lung biopsies are performed in a lobe

CPT code 31629 should be reported only once for upper airway biopsies, regardless of how many transbronchial needle aspiration biopsies are performed in the upper airway or in a lobe.

CPT code 31633 should be reported only once, regardless of how many transbronchial needle aspiration biopsies are performed in the trachea or the additional lobe.

When reporting codes 31654 with 31625 and 31628, it is important to note that the biopsy(-ies) were not taken with the assistance of EBUS. If the biopsy is taken using EBUS, neither 31625 nor 31628 applies; instead, report the appropriate EBUS biopsy code.