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US BX of Prostate and Fine Needle Aspiration


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Our urologists have started a new procedure for collection cell samples in the prostate lobe for better diagnosing prostate ca. They are doing the ultrasound biopsy of the prostate with 12 core samples and also doing fine needle aspiration of the right and left lobe. The op report reads as 2 separate procedures. When we spoke to the coding rep from the company who is promoting this new cell diagnosing, they state they billed Medicare for 55700, 76942, 76872 and 10022 but did not get paid for the 10022. In the NCCI edit, it shows 55700 and 10022 can be billed together with the appropriate modifier. The coding rep did not state if they tried to appeal or not.

We want to bill for everything the physician is doing but not overbill. I am looking for any information to help us. We are thinking all 4 codes should be billed and then appeal if Medicare does not pay showing it is in the NCCI edit as not being bundled.