Magnetic resonance imaging (MRI)-guided prostate biopsy is more accurate and specific in  compare to traditional two-dimensional (2D) transrectal ultrasound (TRUS)-guided biopsy or perineal biopsy.

Magnetic resonance imaging (MRI)-guided prostate biopsy has three technique:-

1. Direct MRI-guided biopsy (in-bore)
2. Cognitive registration
3. MRITRUS fusion Biopsy

Direct MRI-guided biopsy

The procedure is performed in the MRI gantry itself.

Cognitive registration

Multi parametric MRI with three-dimensional (3D) processing images, and mentally determines the location of lesions concerning for cancer, and subsequently targets these areas during TRUS biopsy.

MRITRUS Fusion Biopsy

The previously obtained MRI images are fused to real-time TRUS images to theoretically allow more specific and precise biopsies; this procedure uses proprietary equipment and can be performed under local or general anesthesia.

CPT codes use for these types of procedures are following:

• 55700 – Biopsy, prostate; needle or punch, single or multiple, any approach
• 76872 – Transrectal ultrasound; this is a diagnostic test for evaluation of the prostate and surrounding structures, looking for abnormalities or suspicious areas worrisome for cancer
• 76942 –  Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation.
• 72195-72197: Magnetic resonance (eg, proton) imaging, pelvis (without, with, or without and with contrast)
• 76376: 3D rendering with interpretation and reporting of computed tomography (CT), MRI, ultrasound, or other tomographic modality with image post-processing under concurrent supervision; not requiring image post-processing on an independent workstation
• 76377: 3D rendering with interpretation and reporting of CT, MRI, ultrasound, or other tomographic modality with image post-processing under concurrent supervision; requiring image post-processing on an independent workstation
• 76498: Unlisted magnetic resonance procedure, (eg, diagnostic, interventional)

Important Facts

• When the multiparametric MRI is performed, the MRI itself and the 3D rendering are typically performed by and billed by the radiologist, and therefore should not be billed by the urologist.
• For MRI-TRUS fusion biopsy, there are no specific CPT codes that describe procedure. In addition, this procedure is considered investigational. The increased costs, the current applicable codes for the urologist are the same three codes used for standard 2D TRUS-guided biopsy (CPT codes 76872, 76942, and 55700). 
• The Urologist can’t bill CPT code 77021 (Magnetic resonance guidance for needle placement [eg, for biopsy, needle aspiration, injection, or placement of localization device], radiologic supervision and interpretation), as this would be the correct code to bill if the patient had been on the MRI gantry.
• Code 76498 (Unlisted magnetic resonance procedure [eg, diagnostic, interventional]) for the additional work of fusing the MRI and the ultrasound, but it is unlikely to be reimbursed.
• A 3D image from the TRUS is being performed and images captured, can be use code (76376 or 76377), but it may be necessary to check with insurance providers to check their coverage policy. Physicians’ offices may choose to have their patients sign an Advanced Beneficiary Notice for procedures that are typically not covered.