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Cpt 55700/76942/76872

  1. #1
    Question Cpt 55700/76942/76872
    Medical Coding Books
    Can all of these codes be billed together for a Prostate Biopsy using Transrectal Ultrasound? It appears in the CCI edits that 76942 and 76872 are not bundled together but there are no indicators on the procedure note that indicate 2 ultrasounds are performed. The procedure note also does not indicate the method of removal for the biopsy.

  2. #2
    Albany, New York
    Refer to the CPT Assistant below:

    Prostate needle biopsy with diagnostic rectal ultrasound
    CPT Assistant, May 1996 Page: 3 Category:

    Additional Ultrasonic Procedures

    We also receive many questions regarding how to report a separate diagnostic ultrasound procedure in addition to a biopsy with ultrasonic guidance. One coding question frequently asked is how to report a diagnostic transrectal ultrasound performed in addition to a prostate biopsy with ultrasound guidance. In this case, to reflect the procedures performed accurately, two ultrasound codes are necessary.

    Reporting a Separate Diagnostic Ultrasound Procedure in Addition to a Biopsy with Ultrasonic Guidance

    To accurately code a prostate needle biopsy with ultrasonic guidance and separate diagnostic transrectal ultrasound, report the following codes:

    Ÿ 76872, to report the transrectal ultrasound;

    Ÿ 76942, to report the ultrasonic guidance used to guide the needle biopsy of the prostate; and

    Ÿ 55700, for the needle biopsy of the prostate.

    Remember, the use of 76872 does not preclude reporting 76942.

    If you keep in mind the intent of the ultrasound procedure codes, coding for the diagnostic ultrasound procedure is also straightforward.

    The intent of code 76872 is to describe a diagnostic transrectal ultrasound. The intent of CPT code 76942 is to describe an ultrasound used to localize a mass or region to be biopsied with a needle, and to guide the needle into the mass or region. By defining the intent of each code, we see that each clearly represents a separate and distinct service. For reporting purposes, both procedures should be appropriately documented.

    CPT Assistant © Copyright 1990–2009 American Medical Association. All Rights Reserved
    Karen Maloney, CPC
    Data Quality Specialist

  3. Default Prostate biopsy with cystoscopy
    In the event of the above would 52204 be the appropriate code to report? Thanks!

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