Prostate Saturation Biopsy (PSB): Correct Coding

Historically, pathology services associated with transperineal Prostate Saturation Biopsy (PSB) have been reported with CPT code 88305. CMS determined that separate billing for transperineal PSB samples resulted in significant overpayments for the amount of work involved in performing these services. Effective for dates of service on or after 1/1/2009, CMS implemented four new HCPCS codes to more accurately represent the pathologic evaluation, interpretation, and report for these services.

CPT code 88305 may not be submitted to report services associated with pathologic evaluation, interpretation, and report for transperineal PSB. The correct HCPCS codes for these services are:

• G0416 – Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 1-20 specimens
• G0417 – Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 21-40 specimens
• G0418 – Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 41-60 specimens
• G0419 – Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, greater than 60 specimens

Documentation in patients’ medical records associated with these services should include:

• Results of prior biopsies
• Evidence of rising PSA and/or
• Digital rectal exam notes documenting the reasonable and necessary performance of testing