# Question about saturation biopsy....



## skpartiss (Oct 28, 2009)

I have a question regarding saturation biopsy of the prostate.  Our doctor did a prostate biopsy and took 24 cores.  He did not use a template to do this.  He coded this as a saturation biopsy.  Is this correct?  Does a template need to be used to use 55706?  What exactly is the difference between 55700 and 55706?  Is it just how many cores are taken?  Any help would be appreciated!


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## tmrang (Aug 7, 2013)

I know this is an old thread but posted anyway in hopes of helping others...

CPT® Assistant  Back  
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 ID  224791 
 Source  CPT® Assistant November 2010, Volume 20, Issue 11 
 Subject  Using Stereotactic Template Guided Saturation Biopsy for the Prostate (Code 55706) 


Description 
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. ?


HTH,
Tonya


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## Abayevster@gmail.com (Jan 23, 2021)

tmrang said:


> I know this is an old thread but posted anyway in hopes of helping others...
> 
> CPT® Assistant  Back
> Print   Preview
> ...


This is so helpful. Thank you for posting.


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## liqgold2@aol.com (Jan 24, 2021)

Excellent review. The main differences are that 55706 must be done under general, epidural, or spinal anesthesia in a hospital operating room via a perineal template. Codes G0417, G0418, and G0419 have been deleted several years ago.
Michael A. Ferragamo MD, FACS, GardenCity, NY


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## KaylaRieken (Feb 3, 2021)

Our physicians started doing transperineal prostate biopsies using a Perineologic device. I sent a couple operative reports into the AUA to ask for coding help and they suggested CPT code 55706. What are your thoughts?

Lubricated ultrasound probe was introduced per rectum. Prostate was visualized and measured in the transverse and sagittal planes, found to be around 50 g measured. There was a suggestion of mild middle lobe enlargement protruding into the bladder. The known lesions in the anterior transition zones were somewhat difficult to assess on ultrasound. There was suggestion of a hypoechoic lesion in the right anterior aspect of the transition zone but less distinct on the left side. A block was performed of the perineum with 2% lidocaine and needle trocar of the Perineolic device was introduced on the left aspect of the perineum. We them performed systematic biopsies on the left with 4 cores taken from the posterior aspect of the prostate, 4 cores from the left base, and  4 cores from the left anterior aspect of the prostate, paying close attention to sample thoroughly the anterior transition zone. The needle trocar was introduced in the right side where systematic biopsies were performed with 4 cores taken from the left anterior aspect of the prostate and 3 cores from the left base. Several of the cores incorporated the lesion seen on the ultrasound, and then 4 core3s were taken from the right posterior aspect of the prostate.


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