How To Use CPT Code 20205

CPT code 20205 describes the procedure for obtaining a deep muscle biopsy to further analyze a suspected medical condition or infection. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 20205?

CPT 20205 is used to describe the procedure for obtaining a deep muscle biopsy. This code is used when a healthcare provider needs to collect a sample of deep muscle tissue for further analysis. The biopsy is performed to investigate a suspected medical condition or infection that affects the deep muscle tissue.

2. Official Description

The official description of CPT code 20205 is: ‘Biopsy, muscle deep.’

3. Procedure

The procedure for CPT code 20205 involves several steps:

1. The patient is appropriately prepped and anesthetized to ensure their comfort during the procedure.
2. The healthcare provider examines the area to be biopsied to identify the targeted muscle.
3. Using a scalpel, the provider makes a small incision in the targeted area.
4. The incision is extended, and the tissues in the area are dissected to visualize the targeted muscle.
5. Once the upper surface of the muscle is visualized, the provider removes a small sample of muscle tissue.
6. The provider preserves and processes the muscle tissue sample for further laboratory examination.
7. The incision is closed in a layered fashion to promote proper healing.

4. Qualifying circumstances

CPT code 20205 is used when the muscle tissue being biopsied is deep below the fascia or beneath other muscles or bones. It is important to differentiate between deep muscle biopsies and superficial muscle biopsies. Deep muscle biopsies involve accessing muscle tissue that is well below the surface, while superficial muscle biopsies are performed just below the skin or superficially below the muscle fascia.

5. When to use CPT code 20205

CPT code 20205 should be used when the healthcare provider needs to obtain a deep muscle biopsy. This code is appropriate when the biopsy involves accessing muscle tissue that is deep below the fascia or under another layer of muscle or bone. If the biopsy is performed just below the surface of the skin or superficially below the muscle fascia, a different code, such as CPT code 20200, should be used.

6. Documentation requirements

To support a claim for CPT code 20205, the healthcare provider must document the following information:

• The reason for the biopsy and the suspected medical condition or infection
• The specific muscle targeted for the biopsy
• The date and details of the procedure, including the incision size and closure method
• The preservation and processing of the muscle tissue sample for laboratory examination
• Any complications or additional procedures performed during the biopsy
• The provider’s signature to authenticate the documentation

7. Billing guidelines

When billing for CPT code 20205, ensure that the procedure meets the criteria for a deep muscle biopsy. The healthcare provider should document the depth of the tissue obtained and the amount of manipulation required to access the biopsy site. It is important to note that CPT code 20205 should not be reported if other codes, such as CPT codes 20206 to 20251, have already been performed in the previous seven days.

8. Historical information

CPT code 20205 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performing a deep muscle biopsy on a patient with suspected muscular dystrophy.
2. A surgeon obtaining a deep muscle biopsy to investigate a suspected infection in a patient’s thigh muscle.
3. An orthopedic specialist performing a deep muscle biopsy to diagnose a tumor in a patient’s leg muscle.
4. A rheumatologist obtaining a deep muscle biopsy to investigate inflammation in a patient’s shoulder muscle.
5. A neurologist performing a deep muscle biopsy to diagnose a nerve disorder in a patient’s arm muscle.
6. An oncologist obtaining a deep muscle biopsy to determine the extent of cancer spread in a patient’s chest muscle.
7. A sports medicine physician performing a deep muscle biopsy to investigate a suspected muscle tear in a patient’s calf muscle.
8. A plastic surgeon obtaining a deep muscle biopsy to assess muscle viability in a patient undergoing reconstructive surgery.
9. An infectious disease specialist performing a deep muscle biopsy to identify the causative agent of a deep tissue infection in a patient’s back muscle.
10. An interventional radiologist obtaining a deep muscle biopsy to investigate a suspected vascular abnormality in a patient’s hip muscle.