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A biopsy of the prostate is a medical procedure that involves the removal of tissue samples from the prostate gland for diagnostic purposes. This procedure is typically indicated when there are signs of prostate enlargement, a palpable mass, or when a patient has an elevated level of prostatic-specific antigen (PSA) in their blood, which may suggest the presence of prostate cancer or other prostate-related conditions. The biopsy can be performed using various techniques, including needle or punch biopsies, which can be conducted through different approaches such as transrectal or transurethral methods. In the context of CPT® Code 55705, an incisional biopsy is specifically performed, which usually involves a transperineal approach. This means that an incision is made in the perineum, the area between the anus and the scrotum, allowing direct access to the prostate gland. The procedure aims to obtain tissue samples from one or more sites within the prostate for further histological evaluation in a laboratory setting, aiding in the diagnosis and management of prostate conditions.
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The procedure is indicated for the following conditions:
The incisional biopsy of the prostate is performed through the following steps:
After the incisional biopsy, patients may experience some discomfort or swelling in the perineal area. It is important for patients to follow post-procedure care instructions provided by their healthcare provider, which may include pain management strategies and guidelines for activity restrictions. Patients should be monitored for any signs of complications, such as excessive bleeding or infection. The tissue samples collected during the biopsy are sent to a laboratory for histological evaluation, and results are typically discussed with the patient in a follow-up appointment to determine the next steps in management based on the findings.
| Short Descr | BIOPSY OF PROSTATE | Medium Descr | BIOPSY PROSTATE INCISIONAL ANY APPROACH | Long Descr | Biopsy, prostate; incisional, any approach | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 116 - Diagnostic procedures, male genital |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| Pre-1990 | Added | Code added. |
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