Mastering Diagnostic Biopsy Coding: Tips and Updates
Understanding the Skin biopsy CPT codes:
Diagnostic Biopsy, a technique involving the removal of tissue or cells and evaluating to assess the severity of underlying ailments or pre-existing illnesses. Skin biopsy plays a crucial role in diagnosis and management of various dermatological conditions. Coding for these could be intricate and time-consuming. Comprehending these codes enables healthcare providers to code and bill skin biopsy procedures correctly and with proper documentation it ensures optimal reimbursement.
Factors influencing Biopsy Code selection:
- Types and surgical methods involved.
- Size, number and complexity of lesions.
- Surgical site specific codes.
- Pathological Examination.
Types and surgical methods involved:
CPT distinguishes the codes for skin biopsy based on the surgical methods such as
- Tangential biopsy of skin (CPT Code 11102): Involving shave, scoop, saucerize, curette, single lesion from the surface of the skin. For each additional lesion +11103
- Punch biopsy (CPT Code 11104-11105): Punching a small round piece of tissue is using a sharp, hollow, circular instrument.
- Incisional Biopsy(CPT Code 11106-11107): Removing a portion of a suspicious area, lump, or abnormal tissue with a vertical incision or wedge.
Size, number and complexity of lesions
As Per CPT guidelines, “Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that [most narrow] margin required for complete excision.”
The provider should measure the lesion and margins prior to excision. This is because the lesion will “shrink” as soon as the incision releases the tension on the skin.
Surgical site specific codes:
For reporting a Biopsy coding the surgical site must be mentioned.
CPT has listed body-area-specific biopsy codes as follows
| Area | Procedure | Code |
|---|---|---|
| Eye | Biopsy of conjunctiva | 68100 |
| Incisional biopsy of eyelid skin including lid margin | 67810 | |
| Ears | Biopsy external ear | 69100 |
| Intranasal | Intranasal | 30100 |
| Lip | Biopsy of lip | 40490 |
| Mouth | Biopsy, vestibule of mouth | 40808 |
| Biopsy of floor of mouth | 41108 | |
| Tongue | Biopsy of tongue; anterior two-thirds | 41100 |
| Biopsy of tongue; posterior one-third | 41105 | |
| Nail | Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds)(separate procedure) | 11755 |
| Penis | Biopsy of penis (separate procedure) | 54100 |
| Vulva perineum | Biopsy of vulva or perineum (separate procedure); 1 lesion | 56605 |
| Each separate additional lesion | +56606 |
We at Shoreline Medical Billing have an updated and well-trained coding team who evaluates and uses the most specific biopsy code, always looking in the CPT Index to verify whether a more specific code is available before defaulting to the CPT codes from the 111xx category.
Pathological Examination:
The specimen sample send for pathological examination should be coded and billed separately.
The code range for benign skin lesion excisions is 11400-11471 and the code rage for malignant skin lesion excisions is 11600-11646.
Tips to be noted for Biopsy coding :
Coding Multiple Biopsy techniques:
When multiple biopsies are performed for the same patient on the same encounter only one primary biopsy code may be reported, depending on the most invasive technique performed.
Here’s a quick guide:
- Tangential (11102) – least invasive
- Punch (11104) – moderate
- Incisional (11106) – most invasive
Having picked the primary code, the matching add-on CPT codes for any additional biopsies (11103, 11105, 11107) can be used.
Documentation and Medical Billing:
- When Documenting the skin biopsy procedures care should be taken to note down in details the surgical method used, site of lesions, the size and number of lesions made along with the pathological reports.
- Clear and detail documentation ensures proper code selection and billing avoids the risk of denials.
- It also ensures compliance with coding regulations.
We at Shoreline have department/specialization specific EHR and practice management tools prioritizing the codes most relevant to the procedures, helping for quick and accurate reimbursements of the claims submitted.
Contact Shoreline for all your billing and coding requirements.