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55700 - biopsy, prostate; needle or punch, single or multiple, any approach

  1. #1
    Question 55700 - biopsy, prostate; needle or punch, single or multiple, any approach
    Medical Coding Books
    Standard 12 core transrectal biopsy - Would this be billed with 55700 with 12 in the services field?
    Deb Stoll

  2. #2
    Portland, Oregon
    Default 55700
    It depends, when a urologist and radiologist perform the procedure together:
    - The urologist reports code 55700.
    - The radiologist reports coe 76942.
    Also, please check the record with code 76872: transrectal echography. It should be bill with the written report document the finding and signed by the physician. Based on the Medicare coverage.
    The mention is taking 10-12 tissue cores has become the standard of care (Wilson &Crawford,2004). Sextant & extended biopsy with 10-12 cores is generally performed with local anesthesia.
    Otherwise, the saturation biopsy involves taking between 20 to 40 cores biopsies. This will be use code 0137T: biopsy, prostate needle saturation sampling for prostate mapping.

    I hope it will help.

    Good luck

  3. #3
    By definition, CPT 52400 includes multiple biopsies. Would the urologist need to indicate the number of biopsies in the claim itself? We typically bill the following set of codes: 55700, 76872, 76942, 64450-59 based on our documentation.

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