Happy New Year!
January brings resolutions, fresh starts, maybe a new diet and also new
CPT codes. There were 5,933 new codes as part of the January 1, 2026,
CPT update. We will look at some of these new updates during the coding
report for the month of January.
There were some changes to how we assign for prostate biopsies. The
American Cancer Society notes the decline in the prostate cancer death
rate from 1993 to 2022. They further note this is most likely due to earlier
detection as well as advances in prostate cancer treatment. Prostate
biopsies are an important part of that detection.
We have all new CPT codes for prostate biopsies. Code 55700, biopsy,
prostate; needle or punch, single or multiple, any approach has been
deleted. With these new codes we have further options for assigning more
specifics.
The new codes are broken down by approach and by imaging. We also
have some new terminology here, sextant. Sextant refers to six separate
areas of the prostate where biopsy samples are taken. CPT identifies
these six areas as right base, right mid, right apex, left base, left mid and
left apex. It is common for a prostate biopsy to include two separate
specimens from each sextant. Some of the new CPT codes will include or
exclude sextant biopsies, so watch for this in your documentation.
Our revised prostate biopsy codes now include the imaging provided.
Another new concept here is ultrasound or MRI fusion. Think of this as a
fusion of the imaging itself, rather than what we think of a fusion procedure.
Here the imaging, either an ultrasound or an MRI is performed, and this
can be done some time prior to the admission for the biopsy procedure. At
the time of the biopsy procedure, another US or MRI is performed and that
imaging is then “fused” with the prior imaging. This is done to make the
lesions easier to locate. The new imaging done at the time of procedure is
overlayed with the previously obtained scan. Be sure to watch for this
documentation in your procedure reports.
Finally, we have new codes for in-bore biopsy. In an in-bore biopsy, the
prostate biopsy is performed while the patient is in the CT or MRI scanner.
This allows for a higher rate of precision in identifying lesions for sampling.
Again, watch for this documentation in your procedure/operative reports.
With any new technologies it is a great idea to do some research, either
google for a description or maybe even a video or animation of the
procedure itself. This is a great opportunity for a coding team meeting or
educational presentation. With these changes it is also important to review
the revised parentheticals.
As an overview, all new prostate biopsy codes are categorized by approach
and by imaging. CPT identifies the approaches as transrectal,
transperineal or in-bore as we just discussed. The imaging code options
are stereotactic template guided, ultrasound or MRI fusion or in-bore
CT/MRI. The ultrasound or MRI fusion imaging option is for targeted
prostate lesions, not sextant biopsies. For all our new prostate biopsy
codes, imaging is included. Imaging will not be coded separately with
prostate biopsies. Our new 2026 prostate biopsy codes are in the range
55705-55715. Revised code 55705 would be assigned for those prostate
biopsies performed without imaging services.
Since this is a big change on a commonly performed procedure, I
encourage you and your coding team to review the new codes, investigate
the procedures, review your documentation and identify areas where
additional coding education and documentation review is needed to ensure
correct and complete code assignment.
