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Source CPTÂ® Assistant November 2010, Volume 20, Issue 11
Subject Using Stereotactic Template Guided Saturation Biopsy for the Prostate (Code 55706)
Using Stereotactic Template Guided Saturation Biopsy for the Prostate (Code 55706)
CPT code 55706, Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance, is now a Category I code that was transitioned from Category III code 0137T, Biopsy, prostate, needle, saturation sampling for prostate mapping. Code 55706 should be used only when a transperineal, template guided saturation biopsy is performed under anesthesia.
There are many differences between the standard sextant biopsy (code 55700, Biopsy, prostate; needle or punch, single or multiple, any approach) and the saturation biopsy. The standard sextant biopsy is performed under local anesthesia using a transrectal approach, and involves 6 to 12 cores for sampling of the tissue. The saturation biopsy must be performed under general anesthesia and uses a transperineal approach. The saturation biopsy involves 35 to 60 biopsies depending on the size of the prostate. The specimens are removed at specified intervals through a template grid. This grid enables the physician to remove cores at 5-mm intervals using a stereotactic approach. This procedure is not meant to sample but rather to enable the systematic collection of samples from the entire prostate gland.
CPT code 55700 may be performed in the nonfacility or office setting, and also the facility setting (which includes hospital inpatient, hospital outpatient or ambulatory surgical center, or ASC). CPT code 55706 can only be performed in the hospital inpatient, hospital outpatient or ASC setting.
Indications for saturation biopsy include a rising prostate-specific antigen (PSA) with previous negative standard biopsy (code 55700), history of prostatic intraepithelial neoplasm (PIN) as diagnosed through previous pathology on prior biopsy, history of a suspicious area on prior biopsy, and focal ablation of prostatic carcinoma.
The description of the procedure states that the stereo-tactic template is positioned over the perineum so that precise and exact coordinates for the biopsy can be taken. The urologist transperineally inserts the needle into the prostate and takes approximately 35 to 60 specimens at 5-mm intervals through the template (grid) and removes. These specimens are placed in containers, recorded, and then sent to pathology.
The Centers for Medicare and Medicaid Services (CMS) developed G-codes for pathologists to use to report the examination of specimens from a saturation biopsy. It is important to advise the pathologist that the cores sent for examination are from a saturation biopsy. Therefore, a discussion should be established between the urology practice and the pathologist who will perform the examination to develop a protocol for identifying specimens from a saturation biopsy. The G-codes are:
G0416 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 1-20 specimens
G0417 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 21-40 specimens
G0418 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 41-60 specimens
G0419 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, greater than 60 specimens
Report the appropriate G-code depending on the total number of cores or specimens taken from the prostate during the saturation biopsy and sent to the pathologist for evaluation and examination. ?
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