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Urology Coding Alert

Reader Question:

55700 Is Only Procedure Code for Prostate Fusion Biopsy

Published on Thu Dec 14, 2017 Print Friendly and PDF PDF

Question: Does the CPT® book include codes for a fusion USP/biopsy or a saturation USP/biopsy? Or do these procedures fall under the code for something else?

Answer: CPT® currently does not include a specific code for a fusion biopsy of the prostate gland (which could be partly due to the fact that many insurance companies consider this to be investigational). There are currently two applicable codes for prostate fusion biopsy:

  • 55700 – Biopsy, prostate; needle or punch, single or multiple, any approach 
  • 76872 – Ultrasound, transrectal.

You could file 76498 (Unlisted magnetic resonance procedure [e.g., diagnostic, interventional]) for the additional work of fusing the MRI and the ultrasound, but know it is unlikely to be reimbursed. Other procedures which can be billed with little chance of being paid include 76376, 76377, 77021, and 72192-72194. These procedures most often are performed by the radiologist who is paid before the fusion biopsy.

Take note: CPT® currently suggests code 55706 (Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance) for saturation prostate biopsies This code has a poor payment history as many insurers consider this procedure investigational. For compliance this procedure is mandated to be performed in hospital under major anesthesia.

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