tadailey
Contributor
Some of my providers do 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. Does this cognitive fusion support billing 55708 (transrectal) or 55709 (transperineal). Op note samples below:
W/cognitive fusion:
Procedure Details: 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.
Counts were correct per nursing staff. The patient was awakened and transported to the recovery room in stable condition. The patient's Foley catheter was removed and he will be given a void trial prior to discharge.
Regular MRI fusion:
Procedure Details: Patient received broad-spectrum antibiotics perioperatively. Sequential compression devices were placed in his lower extremities. He was taken the operative suite placed under general anesthesia. He was placed in the left lateral decubitus position. Proper surgical timeout was performed. Transrectal sound imaging was performed in the proper fusion steps were performed. Transrectal ultrasound volume was 27.5g, MRI T2 weighted volume was 27.8g. A total of 15 biopsies were obtained. 12 systematic biopsies at the appropriate positions were performed. In addition 3 biopsies of each MRI identified lesion were obtained (1ROI). Patient tolerated procedure well was transferred the recovery room in stable condition.
W/cognitive fusion:
Procedure Details: 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.
Counts were correct per nursing staff. The patient was awakened and transported to the recovery room in stable condition. The patient's Foley catheter was removed and he will be given a void trial prior to discharge.
Regular MRI fusion:
Procedure Details: Patient received broad-spectrum antibiotics perioperatively. Sequential compression devices were placed in his lower extremities. He was taken the operative suite placed under general anesthesia. He was placed in the left lateral decubitus position. Proper surgical timeout was performed. Transrectal sound imaging was performed in the proper fusion steps were performed. Transrectal ultrasound volume was 27.5g, MRI T2 weighted volume was 27.8g. A total of 15 biopsies were obtained. 12 systematic biopsies at the appropriate positions were performed. In addition 3 biopsies of each MRI identified lesion were obtained (1ROI). Patient tolerated procedure well was transferred the recovery room in stable condition.
