Urology Coding Alert

Question: A colleague recently told me that he bills for both the ultrasonic guidance and the transrectal echography codes when performing a standard prostate biopsy. Is the transrectal echography really separately billable?

Florida Subscriber

Answer: You should thank your colleague the next time you see him or her for making you aware of this often-disregarded reimbursement opportunity. Many urologists assume 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach), 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), and 76872 (Echography, transrectal) produce a CCI edit, but they do not. Consequently, they are not billing for the transrectal echography, a procedure averaging $100 in reimbursement per encounter. So the answer is yes, you can bill separately for the transrectal echography.

Unfortunately, quite a few managed-care payers are bundling 76942 and 76872. For our readers who are members of the AUA, you can call and request a letter of support from the AUA that you can submit with your appeal should your claim be denied.