CPT® Code 96932

Official Description

Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, first lesion

Common Language Description

Reflectance confocal microscopy (RCM) is a sophisticated, non-invasive imaging technique utilized for the detailed examination of skin lesions at the cellular and sub-cellular levels. This procedure is particularly valuable in the assessment of skin conditions, allowing healthcare professionals to investigate both benign and malignant tumors that may arise from melanocytes, which are pigment-producing cells, and keratinocytes, the predominant cell type in the outer layer of the skin. During the RCM process, a near-infrared light emitted from a diode laser is precisely focused on the targeted area of the skin. As this light penetrates the cellular structures, it interacts with them, resulting in variations in the refraction indexes and natural light reflections. These interactions are captured and processed using advanced computer software to create a two-dimensional grayscale image that reveals intricate microscopic details of the skin lesion. The high-resolution images generated through this technique can facilitate a histological analysis, providing critical insights into the nature of the lesion being examined. It is important to note that CPT® Code 96932 specifically pertains to the image acquisition of the first lesion using RCM, without the inclusion of interpretation or reporting. This code is distinct from others in the RCM coding family, such as code 96931, which encompasses both image acquisition and interpretation for the first lesion, and code 96934, which applies to each additional lesion beyond the first. Understanding these distinctions is essential for accurate medical coding and billing practices in dermatology and related fields.

1. Indications

The procedure of reflectance confocal microscopy (RCM) is indicated for the evaluation of various skin lesions, particularly when there is a need to differentiate between benign and malignant conditions. The following conditions may warrant the use of RCM:

Skin Lesions The procedure is performed to assess suspicious skin lesions that may require further investigation to determine their nature.
Melanocytic Tumors RCM is utilized to investigate lesions that may be indicative of melanoma or other melanocytic tumors.
Keratinocytic Tumors The technique is also applicable for examining keratinocyte-derived tumors, aiding in the diagnosis of conditions such as squamous cell carcinoma.

2. Procedure

The procedure of reflectance confocal microscopy (RCM) involves several key steps to ensure accurate imaging of the skin lesions. The following outlines the procedural steps:

Step 1: Preparation of the Patient The patient is positioned comfortably, and the area of the skin to be examined is cleaned to remove any debris or contaminants that may interfere with imaging.
Step 2: Application of the RCM Device The RCM device is then applied to the skin lesion. The device utilizes a diode laser to emit near-infrared light, which is focused on the targeted area.
Step 3: Image Acquisition As the laser light penetrates the skin, it interacts with the cellular structures, producing various reflections and refractions. The device captures these interactions, and the data is processed to create a two-dimensional grayscale image of the lesion.
Step 4: Data Processing The captured images are processed using specialized computer software, which reconstructs the microscopic details of the skin lesion, allowing for a detailed visual analysis.

3. Post-Procedure

After the reflectance confocal microscopy procedure, there are no specific post-procedure care requirements mentioned in the provided data. However, it is generally advisable for patients to follow any standard post-procedural instructions provided by their healthcare provider. Patients may be monitored for any immediate reactions to the procedure, although RCM is non-invasive and typically does not result in significant discomfort or recovery time. Follow-up appointments may be scheduled to discuss the findings from the imaging and any further necessary actions based on the results.

Short Descr	RCM CELULR SUBCELULR IMG SKN
Medium Descr	RCM CELULR & SUBCELULR SKN IMGNG IMG ACQUISITION
Long Descr	Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, first lesion
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	3 - Technical Component Only Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	02 - Procedure must be performed under the direct supervision of a physician.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
Berenson-Eggers TOS (BETOS)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	1

This is a primary code that can be used with these additional add-on codes.

96935

Addon Code MPFS Status: Active Code APC N Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, each additional lesion (List separately in addition to code for primary procedure)

Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.

This service has been performed in part by a resident under the direction of a teaching physician