Summary & Overview
CPT 32400: Percutaneous Pleural Biopsy, Diagnostic Tissue Sampling
CPT code 32400 denotes a percutaneous pleural biopsy: a needle-based procedure to obtain pleural tissue for pathological analysis. This code is important nationally because pleural biopsies play a central role in diagnosing pleural malignancy, tuberculosis, and other causes of pleural disease, influencing downstream treatment decisions and utilization of advanced therapies.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and what to expect from payer coverage and billing perspectives. The publication outlines common modifiers and coding considerations, benchmarks for claim processing and denial patterns where available, and recent policy or guideline updates that affect clinical documentation and medical necessity justification.
This summary equips revenue cycle staff, clinicians, and policy analysts with a focused reference on CPT code 32400: its clinical purpose, billing context, and the types of documentation and claim components that commonly accompany percutaneous pleural biopsy services. Data not available in the input will be identified where applicable.
Billing Code Overview
CPT code 32400 describes a percutaneous pleural biopsy in which the provider obtains tissue samples from the pleura using a needle and sends specimens for pathological analysis. This procedure is a diagnostic pleural intervention used to evaluate pleural disease, including suspicion for malignancy, infection, or other inflammatory processes.
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Service type: Percutaneous pleural biopsy (diagnostic tissue sampling)
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Typical site of service: Hospital inpatient, hospital outpatient, or ambulatory surgical center, depending on patient stability and clinical setting.
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of smoking and progressive shortness of breath presents with a persistent unilateral pleural effusion on chest radiograph and CT scan. The pulmonologist performs a percutaneous pleural needle biopsy using image guidance (ultrasound or CT) to obtain tissue samples for histopathology and microbiology to distinguish malignant pleural disease from infectious or inflammatory causes. The procedure is typically done in an interventional radiology suite or procedure room, with local anesthesia and conscious sedation as needed. The samples are submitted to pathology and cytology; the clinician documents indication, consent, imaging guidance used, number of passes, any immediate complications (e.g., pneumothorax), and disposition. Billing uses CPT 32400 for the percutaneous pleural biopsy with tissue sent for pathological analysis. Typical encounter includes pre-procedure evaluation, the biopsy procedure, post-procedure monitoring including chest radiograph if clinically indicated, and communication of results to the ordering clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation portion of a diagnostic service (rare for this procedure). |