CPT code 32096 is used for a surgical procedure involving an open wedge resection or biopsy of a lung infiltrate.
CPT code 32096 is used to describe a surgical procedure known as an "open wedge resection" or biopsy of a lung infiltrate. This procedure involves making an incision in the chest to access the lung and remove a small, wedge-shaped piece of lung tissue. The purpose of this procedure is typically to obtain a tissue sample for diagnostic evaluation, often to investigate abnormalities such as masses, nodules, or infiltrates that have been detected through imaging studies. This code is essential for healthcare providers to accurately document and bill for the surgical service provided.
For CPT code 32096, which pertains to an open wedge biopsy of a lung infiltrate, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to unusual anatomy or complications during the procedure.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both lungs, this modifier indicates that the service was performed bilaterally.
3. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform distinct parts of the procedure, this modifier indicates that both surgeons were necessary for the completion of the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient needs to return to the operating room unexpectedly for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier indicates their involvement.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
CPT code 32096 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. However, coverage can vary based on local policies established by the MAC, which administers Medicare claims and determines coverage specifics in different geographic areas.
Therefore, to ascertain if CPT code 32096 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and verify with their local MAC for any additional coverage criteria or restrictions.
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