CPT code 32098 is for an open biopsy of the lung pleura, a procedure to obtain tissue samples for diagnostic examination.
CPT code 32098 is used to describe a medical procedure known as an open biopsy of the lung pleura. This procedure involves surgically accessing the pleura, which is the membrane surrounding the lungs, to remove a small sample of tissue for examination. The purpose of this biopsy is typically to diagnose or rule out conditions affecting the pleura, such as infections, cancer, or other diseases. The "open" aspect of the procedure indicates that it is performed through a surgical incision, allowing direct access to the pleura for tissue sampling.
For CPT code 32098, which pertains to an open biopsy of the lung pleura, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: If the open biopsy of the lung pleura is performed in conjunction with other procedures during the same surgical session, this modifier indicates that multiple procedures were performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is particularly relevant if the biopsy is performed in a different anatomical site or through a separate incision.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved and each is performing a distinct part of the procedure.
5. Modifier 66 - Surgical Team: When the procedure requires a team of surgeons due to its complexity, this modifier is used to indicate that a surgical team was necessary.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is used to indicate the repeat nature of the service.
7. Modifier 77 - Repeat Procedure by Another Physician: If another physician repeats the procedure on the same day, this modifier is used to indicate that the repeat procedure was performed by a different physician.
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 for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier is used to indicate the distinct nature of the service.
These modifiers help provide additional context and specificity to the billing and documentation of the procedure, ensuring accurate reimbursement and compliance with coding guidelines.
CPT code 32098 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the actual reimbursement for CPT code 32098 can vary based on local coverage determinations (LCDs) made by the MAC, which may impose specific criteria or documentation requirements for coverage.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 32098 with their respective MAC to ensure compliance with Medicare's billing and coding policies.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 32098, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
