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Urology Coding Alert

Reader Questions:

Limit 55700 to Once Per Encounter

Published on Sat Sep 18, 2010

Question: When doing a prostate biopsy, my physician always performs 12 biopsies. The codes I use are 76872, 76942, 55700, CPT 96372-59, and J1580. Is there any way to get reimbursed for all 12 of the biopsies? Medicare will not even pay the 55700 at all if I bill with 12 units although some of the other payers have paid me. What is the correct way to bill for multiple prostate biopsies? Rhode Island SubscriberAnswer: Code 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach) includes single or multiple needle biopsies of the prostate gland. To try to bill 55700 multiple times or with multiple units is incorrect coding. Audit proof: Recently following a payer's intense audit a large urological group was required to refund a significant amount of revenue and fines for inappropriate use of 55700, when the carrier discovered that the urology group had billed and [...]
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