Coding tips for CPT code 20200 & 20205 (Muscle biopsy)

A muscle biopsy is a procedure used to diagnose diseases involving muscle tissue. The provider will remove tissue and cells from a specific muscle and view them microscopically. Your provider will only need to remove a small piece of tissue from the designated muscle. The muscle can be superficial (Situated nearer the surface of the body) or deep(situated far beneath the surface). In medical coding, we have separate code for superficial and deep muscle biopsy. CPT code 20200 is used for superficial muscle biopsy & code 20205 is used for coding deep muscle biopsy.

Before also we have discussed about breast biopsy, lung biopsy, thyroid biopsy, axillary lymph node biopsy. Here, also the CPT code 76942, 77002, 77012, 77021 should be used as imaging guidance with muscle biopsy.

20200 – Biopsy, muscle; superficial

20205 – Biopsy, muscle; deep

Coding tips for CPT code 20200 & 20205 (Muscle biopsy)

Details of CPT code 20200 & 20205

An incisional biopsy is performed on superficial (CPT code 20200) or deep (CPT code 20205) muscle tissue. This procedure is typically done to diagnose diseases involving muscle tissue, such as muscular dystrophy, myasthenia gravis, polymyositis, dermatomyositis, amyotrophic lateral sclerosis (ALS), Friedreich’s ataxia, and trichinosis or toxoplasmosis parasitic infections of the muscles. The planned biopsy site is first cleansed and then an incision is made in the muscle and a tissue sample is obtained. The tissue sample is then sent for separately reportable pathology examination.

Report CPT code 20200 for muscle biopsy involving a superficial incision or 20205 if a deeper incision with tissue dissection must be made to access the site.

Do not get confused core biopsy with Fine needle aspiration.

Aslo, Fine needle aspiration (FNA) (CPT codes 10021) should not be reported with another biopsy procedure code for the same lesion unless one specimen is inadequate for diagnosis. For example, a FNA specimen is usually examined for adequacy when the specimen is aspirated. If the specimen is adequate for diagnosis, it is not necessary to obtain an additional biopsy specimen. However, if the specimen is not adequate and another type of biopsy (e.g., needle, open) is subsequently performed at the same patient encounter, the other biopsy procedure code may also be reported with an NCCI-associated modifier

Modifiers used with CPT code 20200 & 20205

51 When multiple procedures, other than E/M services, physical medicine and rehabilitation services, or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s).

59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day.

GC This service has been performed in part by a resident under the direction of a teaching physician