Are Cognitive MRI Fusion Biopsies Reported With MRI Fusion Codes?
Question: Some of our urologists perform a cognitive MRI fusion transrectal or transperineal prostate biopsy. My understanding is that the providers “mentally” align the MRI images when they do the biopsies. Here is an example of one of the cognitive fusion op notes: The patient was taken to the operating room where he is placed under IV general anesthesia in the lithotomy position and a Foley catheter was placed under sterile condition to drain the bladder. The transrectal ultrasound probe is inserted into the rectum. Prostate is visualized in the transverse and sagittal views obtaining information as noted above. The precision point attachment device is placed onto the probe. A perineal block is provided with 10 cc of half percent plain Marcaine. The precision point attachment probe was placed into the perineum and then the biopsies were performed according to the standard 10 zone mapping template for the perineal biopsy. Generally, 2 or 3 samples were taken from each zone. MRI lesion was identified and separately sampled. The ultrasound probe was then removed. Does this cognitive fusion support billing 55708 for a transrectal prostate biopsy or 55709 for a transperineal prostate biopsy? South Carolina Subscriber Answer: No, you cannot bill for an MRI fusion biopsy when the provider performs a cognitive MRI fusion prostate biopsy. The work involved to use software to merge the MRI images with the real-time ultrasound guidance is part of the reimbursement for 55708 (Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance, first targeted lesion) and 55710 (Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance biopsy, first targeted lesion), which is not done with a cognitive biopsy. Cognitive biopsies are billed like ultrasound-guided biopsies. Using the op note example you’ve provided, you’d use 55709 (Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])) to report the procedure. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
