Ask the Expert

This month’s selection:
I am new to coding biopsies from saturation prostate cases. With G0416 10-20 biopsies, what is the correct way to code 12 separately identified containers?

On the lab side, I need to know whether we should be worried more about the number of biopsies and not how they were obtained. The change in the number of biopsies seems to have caused confusion.

We need help with which code to use and when either 88305 or G0416 should be used on biopsies not from saturation procedure.

We are receiving 12 biopsies in a quadrant approach: left and right each base, mid, apex, then right and left each lateral base, mid, apex.

So, per article, we are wondering, even if these are not clinically coded saturation biopsy cases, do we still need to use the G code for the 10-12 containers?

Kathleen T. Randall, CT(ASCP), BS, CPC
University of Alabama at Birmingham

 

Response:
Because G0416 is specifically for saturation biopsies, I would stick with that code if the operative report or similar documentation states that the procedure was a saturation biopsy.

Per the November 2010 CPT Assistant, there are distinct differences between the saturation biopsy and standard biopsy. “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.”

From the July 2005 CPT Assistant, 88305 would be assigned regardless of the number of samples obtained if from the same specimen. Again, it goes back to the method of biopsy (standard or saturation).

— Tracy Wingate, CCS, is a coding compliance auditor at TrustHCS.