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Transrectal Ultrasound guided (TRUS) Biopsy: Overview and Coding

A transrectal ultrasound (TRUS) may also be called prostate sonogram or endorectal ultrasound. It is used to look at the prostate and tissues around it. An ultrasound transducer (also called a probe) sends sound waves through the wall of the rectum and into the prostate and surrounding tissue.

A transrectal ultrasound of the prostate gland is typically used to help diagnose symptoms such as: a nodule felt by a physician during a routine physical exam or prostate cancer screening exam. An elevated blood test result, difficulty urinating.

Prostate ultrasound and biopsy both evaluate the abnormal results of a digital rectal exam or an elevated prostate-specific antigen (PSA) blood test. Prostate ultrasound involves a probe about the size of a finger that is inserted a short distance into the rectum.

A suspicious area to biopsy or may take samples from several places in prostate. Generally, 10 to 12 tissue samples are taken. The entire procedure usually takes about 10 minutes.

Transrectal ultrasonography (TRUS) is a way of creating an image of the prostate gland using sound waves. In conventional ultrasound procedures, a probe placed against the skin sends painless, ultra-high-frequency sound waves into the body.

One of the more useful applications of MRI is in locating cancer that has not shown up on a biopsy. This can be very helpful to a man who has not yet been diagnosed with prostate cancer despite having an elevated PSA and continued biopsies that come back as being “negative,” meaning there is no evidence of cancer.

CPT Codes

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)

Remembering Point

Doctors almost always perform needle biopsies of the prostate (CPT code 55700) under ultrasonic guidance for needle placement (CPT code 76942), and frequently do them in addition to transrectal echography (CPT code 76872). Then all three codes are reported separately.

Urologists are injecting Xylocaine or some other type of local anesthetic into the prostate. The AMA includes “local infiltration, metacarpal/metatarsal/digital block or topical anaesthesia” as part of the description of the CPT Surgical Package Definition. This type of injection would be considered local infiltration. According to the NCCI, Medicare does not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service. In this case, payment for the anesthesia service is included in the payment for the medical or surgical procedure.

There is some controversy on the billing of the nerve block, 64450 Injection, anesthetic agent; other peripheral nerve or branch with a transurethral ultrasound (TRUS) and ultrasound guided biopsy. If the urologist is performing a nerve block on a Medicare patient, they should not bill the CPT® code 64450 with the TRUS with biopsy.

For a transperineal prostate biopsy with mapping instead of a transrectal prostate biopsy use CPT 55706 –Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including image guidance.

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