Coding Biopsies and Lesion Removal
Biopsies
CPT deleted biopsy code 11100 and add on code 11101 in 2021 and introduced three base codes and three add on codes that are defined by the method of biopsy - tangential, punch or incisional - rather than size or anatomic location. Simple closure, when needed, is included in the payment for all three biopsy types and should not be billed separately.
New Biopsy Codes
11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette), single lesion
+11103 Each additional lesion
11104 Punch biopsy of skin (including simple closure, when performed), single lesion
+11105 Each additional lesion
11106 Incisional biopsy of skin (e.g. wedge; including simple closure, when performed), single lesion
+11107 Each additional lesion
Tangential biopsies (codes 11102-11103) These are not considered excisional biopsies, which remove the entire lesion with margins.
Punch biopsies (codes 11104-11105) use a punch tool to remove a full thickness cylindrical sample of the skin.
Incisional biopsies (codes 1106-11107) use sharp blade to remove a full thickness sample of tissue via a vertical incision or wedge, penetrating deep to the dermis and into the subcutaneous space. This method may sample subcutaneous fat.
When multiple biopsies are performed for the same patient on the same date, only one primary biopsy code may be reported, depending on the following:
If multiple biopsies are performed using the same technique, report the primary code with highest RVU, then use the corresponding add on code for the other biopsies.
If multiple biopsies are performed using different techniques, report the primary code with the highest RVU, then use the add on code that is specific to the other biopsies performed.
Shave Biopsies (codes 11300-11313) use a sharp instrument to remove epidermal or dermal lesions without a full thickness excision. Shave biopsy codes are selected based on the location and size of the lesion.
Excision Biopsies (Benign Codes 11400-11471) (Malignant Codes 11600-11646) These codes are for full thickness removal and should be selected based on the lesion type, the location, and the size of the excision, not the size of the lesion itself. Because excision codes depends in part on lesion type, you must wait to submit the claim until after you receive the pathology report.
Destruction of Benign, Premalignant, and Malignant Lesions
Destruction of premalignant lesions (actinic keratoses) should be billed based on the number of lesions. First one should be billed with code 17000, each additional lesion up to 14 code 17003. The destruction of 15 or more lesions should be billed using code 17004.
For the destruction of benign lesions (seborrheic keratoses and warts) bill a single unit of code 17110 to treat up to 14 lesions and a single unit code 17111 for 15 or more.
Removing skin tags can be tricky as payers may consider the procedure cosmetic and not cover it. Document whether the skin tags are irritated or bleeding. Use a single unit of code 11200 for removing up to 15 lesions, and use add on code 11201 for each additional block of up to 10 more.
The coding for destruction of malignant lesions is different than for benign lesions. Use a code from the 17260-17286 range for each lesion, and select the code based on the location and size of the lesion, not the defect. These codes include local anesthesia and are used for all destruction methods, including electrosurgery, cryosurgery, laser treatment, and chemical treatment.
Note that specific codes exist for destruction of benign and premalignant lesions on the mouth, eyelid, conjunctiva, anus, penis, vulva, and vagina. These codes should be used instead of codes in the integumentary system section of CPT.
Performing Multiple Procedures on the Same Day
Multiple skin procedures are often performed at the same patient visit. To bill these correctly and avoid denials, follow three step:
Check the total RVUs for each code to determine which is valued highest.
Check the National Correct Coding Initiative (NCCI) edits.
Report the highest valued code on the claim form without a modifier. If the second procedure is the ame as the first or is bundled into the first based on NCCI edits, submit that code too, with modifier 59. If the second procedure is not bundled into the first, use modifier 51.
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