Summary & Overview
CPT 32097: Open Surgical Biopsy of Abnormal Lung Mass
CPT code 32097 identifies an open surgical incision into the pleural space with biopsy of one or more abnormal lung masses. This diagnostic procedure is used when tissue sampling via less invasive methods is insufficient or not feasible; it has implications for staging, treatment planning, and definitive diagnosis of pulmonary masses. Nationally, surgical lung biopsies remain important for cases requiring larger tissue samples or when tumor location or patient anatomy limits percutaneous or bronchoscopic approaches. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a compact briefing on the clinical context and service setting for 32097, payer coverage considerations, and typical billing and reporting practices. The publication covers benchmarks and reimbursement context where available, recent policy updates affecting surgical lung biopsy coverage, and clinical considerations that influence site-of-service and documentation. Practical information on associated procedure coding and common modifiers is summarized elsewhere in the full publication. Data not available in the input is noted where specific payer policies, related codes, or ICD-10 pairings are required for claim-level guidance.
Billing Code Overview
CPT code 32097 describes an open surgical procedure in which the provider makes an incision into the pleural space of the chest to obtain one or more biopsies of an abnormal lung mass. This procedure is a diagnostic surgical biopsy of lung tissue performed via an open thoracotomy or similar open access to the pleural cavity.
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Service type: Open surgical lung mass biopsy (diagnostic surgical procedure)
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Typical site of service: Hospital operating room or inpatient surgical suite; may also occur in ambulatory surgery centers when clinically appropriate
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old current or former smoker who presents with persistent cough, hemoptysis, and an enlarging peripheral pulmonary nodule identified on chest radiograph and chest CT. After multidisciplinary review and consideration of less invasive approaches (bronchoscopic biopsy, CT-guided percutaneous needle biopsy), the thoracic surgery team elects to perform an open transthoracic surgical biopsy of the lung mass to obtain adequate tissue for histopathology and molecular testing.
Preoperative workflow includes history and physical, pulmonary function testing, chest CT, coagulation assessment, and informed consent documenting the indication and risks (bleeding, pneumothorax, infection). In the operating room under general anesthesia with single-lung ventilation as needed, the surgeon makes a thoracotomy or limited thoracotomy/mini-thoracotomy incision, enters the pleural space, visualizes the lesion, and takes one or more excisional or incisional biopsies of the abnormal lung mass. Specimens are labeled and sent to pathology. Hemostasis is achieved, chest tube(s) placed as indicated, and the chest closed. Postoperative care includes chest radiographs to assess for pneumothorax, pain control, chest tube management, and monitoring for respiratory complications. Final operative documentation should describe approach, laterality, number and type of biopsies, specimens submitted, drains placed, estimated blood loss, and any intraoperative complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |