2023 Coding Tips: Prostate Biopsy Coding

Prostate biopsies are performed via different approaches and techniques. The coding of these procedures can be very nuanced. It is important to recognize and distinguish the work associated with the different CPTs for prostate biopsy procedures. This will help ASCs obtain authorizations and anticipate the correct reimbursement.

55700 vs. 55706

CPT 55700 and 55706 are similar. Their descriptions are as follows:

• 55700 — Biopsy, prostate; needle or punch, single or multiple, any approach
• 55706 — Biopsy, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance

The main differences between these codes are:

1. Approach — 55700: any approach | 55706: transperineal approach
2. Anesthesia — 55700: local anesthesia | 55706: general anesthesia
3. Number of biopsies — 55700: 6-12 biopsies | 55706: 35-60 biopsies
4. Use of template/grid — 55700: no template or grid needed | 55706: requires use of template or grid to perform systematic collection of specimens from the entire prostate gland

The surgeon should document the use of a template or grid when utilized and indicate the number of specimens obtained. This will allow for more accurate code assignments.

Imaging Guidance

55706 includes all imaging guidance, so ultrasound, fluoroscopy, radiology, or MRI fusion are not coded or reported separately. 55700 does not include imaging guidance, so any imaging codes are reported separately.

76872 — Ultrasound, transrectal bundles with 76942 — Ultrasound guidance for needle placementper NCCI edits. Documentation must clearly describe the ultrasounds are studying different aspects of the anatomy and biopsy procedure to code and report both ultrasounds.

MRI TRUS fusion is currently coded as 76999 — Unlisted ultrasound procedure per the July 2018 issue of AMA's CPT Assistant.