Report CPT code 55700 for a prostate gland biopsy with a perineal, transurethral, transrectal, or another approach.
1. What Is CPT Code 55700?
CPT 55700 covers a biopsy procedure of the prostate gland with a special needle or can be performed during a pathological examination surgery.
55700 may be billed for the transurethral, perineal, transrectal, or other approaches.
The CPT book describes 55700 as follows: “Biopsy, prostate; needle or punch, single or multiple, any approach.”
The 55700 CPT code procedure aims to remove small samples from the patient’s prostate gland with a special biopsy needle to test for abnormal cell growth to detect diseases like cancer.
The 55700 procedure can be performed with the following approaches.
3.1 The Perineal Method
CPT 55700 can be performed with the perineal method. The provider begins this procedure by cleaning the perineum with antiseptic before they use an ultrasound probe for needle placement and moving it into the patient’s rectum.
Then, they insert the biopsy needle into the patient’s prostate (through the perineum) before they use the needle to obtain a tissue sample which will be sent to pathology so it can be examined.
3.2 The Transurethral Method
The transurethral method is another approach for the 55700 procedure.
The provider also starts this procedure by cleaning the perineum with antiseptic before inserting an ultrasound probe into the patient’s rectum for ultrasound guidance.
Then, they insert the needle through the perineum, move it into the patient’s prostate, and take a sample of tissue that will be sent to pathology for examination.
3.3 The Transrectal Method
The 55700 procedure can also be performed with the transrectal approach.
This approach starts with cleaning the site with antiseptic liquid before the provider inserts the needle through the wall of the patient’s rectum.
Then, they use the needle to obtain tissue samples to be sent to pathology for examination.
4. How To Use CPT Code 55700
Use CPT code 55700 together with CPT 76872 and CPT 76942 and without modifiers if a urologist alone performs a prostate biopsy with ultrasonic guidance and a transrectal echography. This can be the case if they perform radiology and surgical services without the help of a radiologist.
Use CPT 55700, CPT 75942 with modifier 26, and CPT 76872 with modifier 26 if the prostate biopsy with ultrasound guidance in a hospital with transrectal echography was performed without a radiologist. The doctor has to document two radiology reports ( transrectal echography and ultrasonic guidance).
Providers can perform this procedure in both -non-facility and facility settings and with or without the presence of a radiologist. Be aware that these circumstances will affect the way you bill the services.
In most cases, the providers use ultrasonic guidance for needle placement billed with CPT code 76942 while performing CPT 55700 or CPT 55706 for needle biopsies of the prostate. Ultrasonic guidance is often performed in addition to transrectal echography billed with CPT code 76872.
The surgeon can only report CPT code 55700 if the radiologist is present during the biopsy, and supervises the radiology procedures, documents, interprets, and reports these services. The hospital is responsible in that case for reporting the radiology services with CPT 76872 and CPT 76942.
Report CPT code 55706 for prostate biopsies with transperineal stereotactic template guided saturation.
Use the following CPT codes if the provider performed a fine needle aspiration biopsy;
- CPT 10021;
- CPT 10012;
- CPT 10011;
- CPT 10010;
- CPT 10009;
- CPT 10008;
- CPT 10007;
- CPT 10006;
- CPT 10005; or
- CPT 10004.
You may use CPT 88173 or CPT 88172 for evaluation of fine needle aspirate.
You can use CPT 77021, CPT 77012, CPT 77002, or CPT 76942 if imaging guidance is performed during this procedure.