How To Use CPT Code 55705

CPT 55705 describes a biopsy procedure performed on the prostate gland to obtain small samples for testing and examination. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55705?

CPT 55705 is used to describe a biopsy procedure performed on the prostate gland. During this procedure, small samples of tissue are removed from the prostate using a special biopsy needle or during surgery. These samples are then sent to a laboratory for testing and examination to determine the presence of cancer or other abnormal cell growth.

2. Official Description

The official description of CPT code 55705 is: ‘Biopsy, prostate; incisional, any approach.’

3. Procedure

1. The healthcare provider performs a prostate biopsy to obtain tissue samples for testing and examination.
2. The biopsy can be performed using different methods, including transrectal, perineal, transurethral, and open approaches.
3. For the transrectal method, the provider inserts a scope through the anus and into the rectum. A needle is then inserted through the scope and into the prostate to obtain tissue samples.
4. For the transurethral method, a cystoscope is inserted through the opening at the end of the penis and into the urethra. Instruments are then inserted through the cystoscope to obtain tissue samples.
5. For the perineal method, the provider cleans the area between the genitalia and anus and inserts a special needle through the perineum to reach the prostate. The needle is then used to extract a small piece of tissue.
6. For the open method, the provider makes a small incision in the skin of the abdomen, exposes the prostate, and collects a small tissue sample using a needle.
7. After the biopsy, the tissue samples are sent to a laboratory for further examination.

4. Qualifying circumstances

CPT 55705 is performed when there is a need to obtain tissue samples from the prostate for testing and examination. It is typically done to determine the presence of cancer or other abnormal cell growth. The procedure can be performed by various healthcare providers and can be done in both facility and non-facility settings.

5. When to use CPT code 55705

CPT code 55705 should be used when a biopsy procedure is performed on the prostate gland to obtain tissue samples for testing and examination. It is important to accurately document the approach used for the biopsy, whether it is transrectal, perineal, transurethral, or open.

6. Documentation requirements

To support a claim for CPT code 55705, the healthcare provider must document the following information:

• Reason for the biopsy and the need for tissue samples
• Approach used for the biopsy (transrectal, perineal, transurethral, or open)
• Date of the procedure
• Details of the procedure, including any complications or additional steps taken
• Signature of the healthcare provider performing the biopsy

7. Billing guidelines

When billing for CPT code 55705, ensure that the procedure meets the criteria for this specific code. It is important to accurately document the approach used for the biopsy and any additional procedures performed during the same session. If the biopsy is performed with the presence of a radiologist, additional codes may need to be reported for the radiology services.

8. Historical information

CPT code 55705 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 urologist performing a transrectal biopsy on a patient to obtain tissue samples for further examination.
2. A surgeon using the perineal approach to perform a prostate biopsy on a patient with suspected cancer.
3. A radiologist performing a transurethral biopsy on a patient under image guidance to obtain tissue samples for testing.
4. An oncologist performing an open biopsy on a patient with abnormal prostate imaging results to determine the presence of cancer.
5. A urologist performing a transrectal biopsy on a patient with elevated prostate-specific antigen (PSA) levels to assess for cancer.
6. A surgeon performing a perineal biopsy on a patient with a family history of prostate cancer to screen for the disease.
7. A urologist performing a transurethral biopsy on a patient with urinary symptoms and suspected prostate abnormalities.
8. An interventional radiologist performing an open biopsy on a patient with a large prostate mass to obtain tissue samples for diagnosis.
9. A urologist performing a transrectal biopsy on a patient with an abnormal digital rectal examination (DRE) to assess for cancer.
10. A surgeon performing a perineal biopsy on a patient with persistent elevated PSA levels to determine the cause.