How To Use CPT Code 55700

CPT 55700 is a code used for prostate biopsy procedures, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 55700?

CPT 55700 is a medical billing code used to describe a prostate biopsy procedure. This code is utilized by medical coders and billers to accurately report and bill for the specific services provided during a prostate biopsy. The code encompasses various approaches to the biopsy, including needle or punch, single or multiple, and any approach.

2. 55700 CPT code description

The official description of CPT code 55700 is: “Biopsy, prostate; needle or punch, single or multiple, any approach.”

3. Procedure

The CPT 55700 procedure involves the following steps:

1. The patient is prepared for the biopsy, which may include administering anesthesia or sedation.
2. The provider selects the appropriate approach for the biopsy, such as transrectal, perineal, or transurethral.
3. Using a special biopsy needle or punch, the provider obtains tissue samples from the prostate gland.
4. The tissue samples are sent to a pathology lab for examination and diagnosis.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 55700 services are those with suspected prostate cancer or other abnormal cell growth in the prostate gland. This may be based on abnormal findings from a digital rectal exam, elevated prostate-specific antigen (PSA) levels, or other clinical indications that warrant further investigation.

5. When to use CPT code 55700

It is appropriate to bill the 55700 CPT code when a provider performs a prostate biopsy using any of the described approaches (transrectal, perineal, or transurethral) and obtains tissue samples for pathological examination. The code should be used regardless of the number of samples taken or the specific biopsy technique used (needle or punch).

6. Documentation requirements

To support a claim for CPT 55700, the following information should be documented:

• Patient’s medical history and clinical indications for the biopsy
• Details of the biopsy procedure, including the approach used and the type of biopsy instrument (needle or punch)
• Number of tissue samples obtained
• Pathology report with the examination and diagnosis of the tissue samples
• Any complications or adverse events related to the procedure

7. Billing guidelines

When billing for CPT code 55700, it is important to follow the appropriate guidelines and rules. This may include using additional codes for imaging guidance (such as 76942, 77002, 77012, or 77021) or fine needle aspiration biopsy (such as 10004-10012 or 10021). Additionally, if a transperineal stereotactic template-guided saturation prostate biopsy is performed, use CPT code 55706 instead of 55700.

8. Historical information

CPT 55700 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 55700

Five similar codes to CPT 55700 and how they differ are:

• CPT 55706: This code is used for transperineal stereotactic template-guided saturation prostate biopsies, which involve a more extensive sampling of the prostate gland.
• CPT 10004-10012: These codes are used for fine needle aspiration biopsies, which involve the use of a thin needle to obtain tissue samples.
• CPT 10021: This code is used for fine needle aspiration biopsy without imaging guidance.
• CPT 76942: This code is used for ultrasonic guidance for needle placement during a biopsy procedure.
• CPT 77002: This code is used for fluoroscopic guidance for needle placement during a biopsy procedure.

10. Examples

Here are 10 detailed examples of CPT code 55700 procedures:

1. A patient with an elevated PSA level undergoes a transrectal needle biopsy of the prostate, with six tissue samples obtained for pathological examination.
2. A patient with a suspicious digital rectal exam result undergoes a perineal punch biopsy of the prostate, with four tissue samples obtained for pathological examination.
3. A patient with a history of prostate cancer undergoes a transurethral needle biopsy of the prostate, with eight tissue samples obtained for pathological examination.
4. A patient with a family history of prostate cancer undergoes a transrectal needle biopsy of the prostate, with ten tissue samples obtained for pathological examination.
5. A patient with a palpable prostate nodule undergoes a perineal punch biopsy of the prostate, with five tissue samples obtained for pathological examination.
6. A patient with a previous negative biopsy but persistently elevated PSA levels undergoes a transurethral needle biopsy of the prostate, with twelve tissue samples obtained for pathological examination.
7. A patient with a positive multiparametric MRI result undergoes a transrectal needle biopsy of the prostate, with seven tissue samples obtained for pathological examination.
8. A patient with a history of atypical small acinar proliferation (ASAP) undergoes a perineal punch biopsy of the prostate, with six tissue samples obtained for pathological examination.
9. A patient with a history of high-grade prostatic intraepithelial neoplasia (HGPIN) undergoes a transurethral needle biopsy of the prostate, with nine tissue samples obtained for pathological examination.
10. A patient with a suspicious lesion on transrectal ultrasound undergoes a transrectal needle biopsy of the prostate, with eleven tissue samples obtained for pathological examination.