What’s New – Beginning January 1, 2021:

1. CPT CODE

2. CODE DESCRIPTION

3. AMA CPT INSTRUCTIONS

OLD – In 2020, the code for a percutaneous lung or mediastinum was:

• 32405   Biopsy, lung or mediastinum, percutaneous needle

NEW – Beginning January 1, 2021, the code and the description will change to:

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

In addition, AMA CPT code instructions were added.  In summary:  The difference between core needle biopsy and fine needle aspiration are explained:

• Core needle biopsy is typically performed with a needle that is designed to obtain a core sample of tissue for histopathologic evaluation
• Fine needle aspiration (FNA) biopsy is performed when material is aspirated with a fine needle and the cells are examined cytologically
• Unlike the current code 32405, image guidance is included in the new code 32408. Guidance codes (ie, 76942 Ultrasound, 77002 Fluoro, 77012 CT, and 77021 MR) may not be reported separately with 32408
• 32408 is reported once per lesion sampled in a single session
• When separate lesions of the lung or mediastinum are biopsied with image guidance in the same session, CPT coding instructions state “…use 32408 once for each lesion with modifier 59 for the second and each additional core needle lung, or mediastinal biopsy.”
• When a needle core biopsy of the lung or mediastinum with image guidance is done at the same time as a core biopsy of another site, both the core needle biopsy for the other site and image guidance may be reported separately with modifier 59
• When FNA biopsy and core needle biopsy of the lung or mediastinum are performed on the same lesion in the same session using the same type of image guidance, assign modifier 52 with either the FNA or the core biopsy
• In the event FNA biopsy and core needle biopsy of the lung or mediastinum are performed on the same lesion at the same session using different types of image guidance, both image-guided biopsy codes may be reported separately and modifier 52 is applied to one of the codes
• When FNA biopsy is performed on one lesion and core needle biopsy of the lung and mediastinum is performed on a separate lesion in the same session using the same type of image guidance, both codes can be assigned and modifier 59 should be appended to one
• When FNA biopsy is performed on one lesion and a core needle biopsy of the lung and mediastinum is performed on a separate lesion in the same session but using different types of image guidance, both the FNA biopsy and 32408 can be coded. Modifier 59 would be appended to one of the codes

NOTES: 

• AMA guidelines may differ from CMS policy.  Be sure to check NCCI Policy Manual for Medicare Services – Effective January 1, 2021 as well as Medically Unlikely Edits.
• 2021 CMS Allowed Amounts for these codes are not yet finalized. We will update this article with the 2021 CMS Allowed Amounts once they are finalized.

For questions on this or other radiology and interventional radiology documentation and coding matters, please contact Wendy Block, CIRCC, RCC and the StreamlineMD coding team at wblock@streamlinemd.com.