Coding Prostate Biopsies

The topic of discussion for “Spotlight on CPT” this month is prostate biopsy coding. This is an area of major change in 2026 CPT codes. This first important criteria that a coding professional needs to identify in order to assign the correct prostate biopsy code is if the biopsy is performed with or without imaging guidance. There is now only one code to identify a prostate biopsy that does not use imaging guidance and that is 55705. This code can be used with any approach.

Nine new prostate biopsy codes identify those procedures performed with imaging guidance. These codes are distinguished by approach (transrectal, transperineal) and by type of imaging guidance (ultrasound, MRI-ultrasound fusion, in-bore CT or MRI-guidance).

 

Source: https://www.chelwest.nhs.uk/your-visit/patient-leaflets/imaging/mri-fusion-trans-perineal-prostate-biopsies-under-general-anaesthesia

 

Let’s clarify a few terms that are found in the new prostate biopsy codes.  First, in-bore biopsies take place with the patient inside the MRI or CT scanner.  The cylindrical opening of these devices is called the bore.  Sextant biopsies are six-part biopsies.  Samples are taken from the top, middle, and bottom on both the right and left sides of the prostate.  This type of biopsy assures a good sample with the ability to obtain a clearer determination of the extent of disease.  The sextant biopsy is the most common type of prostate biopsy. 

Here is a rundown of the new prostate biopsy codes:

55707    Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])

55708    Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance, first targeted lesion

55709    Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])

55710    Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance biopsy, first targeted lesion

55711    Biopsy, prostate, transrectal, MRI-ultrasound-fusion-guided, targeted lesion(s) only, first targeted lesion

55712    Biopsy, prostate, transperineal, MRI-ultrasound-fusion-guided, targeted lesion(s) only, first targeted lesion

55713    Biopsy, prostate, in-bore CT- or MRI-guided (ie, sextant), with biopsy of additional targeted lesion(s), first targeted lesion

55714    Biopsy, prostate, in-bore CT- or MRI-guided targeted lesion(s) only, first targeted lesion

+55715  Biopsy, prostate, each additional, MRI-ultrasound fusion or in-bore CT- or MRI-guided targeted lesion

 

Now, light has been shed on coding prostate biopsies.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.