Skin biopsy codes are changing.
EDITOR’S NOTE: This is an updated version of the second installment in a two-part series on the 2019 CPT® codes released recently by the American Medical Association.
For many years we have used two codes to report skin biopsies. CPT® 11100 for the first lesion and 11101 for each additional lesion biopsied after the first lesion on the same date of service.
These codes included all methods of removal. The new code ranges are CPT 11102-11107 and are reported based on method of removal which allows for greater specificity. New guidelines were created to help with coding and reporting of these codes. The new CPT codes are as follows:
Biopsies are used to obtain tissue for diagnostic histopathologic examination performed independently, or unrelated or distinct from other procedures/services. When a skin lesion is entirely removed, either by excision or shave removal and sent to pathology for examination, it is not considered a biopsy for coding purposes but an excision and should be reported with the excision codes not biopsy CPT codes. When a biopsy is performed on different lesions or different sites on the same day, each biopsy may be performed separately as they are not considered components of other procedures.
The CPT Guidelines state: “Partial-thickness biopsies are those that sample a portion of the thickness of skin or mucous membrane and do not penetrate below the dermis or lamina propria, full-thickness biopsies penetrate tissue deep to the dermis or lamina propria, into the subcutaneous or submucosal space.
Sampling of stratum corneum only, by any modality (e.g., skin scraping, tape stripping) does not constitute a skin biopsy procedure and is not separately reportable. An appropriate biopsy technique is selected based on optimal tissue-sampling considerations for the type of neoplastic, inflammatory, or other lesion requiring a tissue diagnosis”.
Prior to the new CPT codes for 2019, biopsies were reported with CPT code 11100 for the first lesion and 11101 for each additional lesion biopsied regardless of method of removal.
The new biopsy codes are reported based on method of removal including:
- Tangential biopsy (11102 and 11103)
- Punch biopsy (11104 and 11105)
- Incisional biopsy (11106 and 11107
A tangential biopsy (11102/11103) includes removal via shave, scoop, saucerization or curette. This type of biopsy is performed with a sharp blade such as a flexible biopsy blade, obliquely oriented scalpel or curette. A sample of epidermal tissues is removed with our without portions of the underlying dermis. This type of biopsy does not involve the full thickness of the dermis. When the full thickness of the dermis is involved the procedure reported is 11300-11313 (removal of epidermal or dermal lesions).
A punch biopsy required a punch tool to remove a full thickness cylindrical sample of the skin. The intent of the biopsy is to remove a sample of a cutaneous lesion for a diagnostic pathologic examination. Simple closure is include and cannot be billed separately.
An incisional biopsy requires the use of a sharp blade (not a punch tool) to remove a full-thickness sample of tissue via a vertical incision or wedge, penetrating deep to the dermis, into the subcutaneous space. An incisional biopsy may sample subcutaneous fat. A simple closure is included with an incisional biopsy even though closure is typically performed. When the entire lesion is excised report the excision codes, 11400-11646 depending on type of lesion (benign or malignant).
Biopsies are selected by method of removal. If more than one biopsy is performed on the same date, only one primary biopsy code is reported. When more than one biopsy is performed using the same technique, the appropriate primary biopsy code is reported for the first biopsy and the add-on code is reported for each additional lesion.
Example #1: A physician performed biopsies on a patient with two suspicious lesions, one on the left arm and one on the left leg via shave technique. The encounter is coded as:
1. 11102 (tangential biopsy of skin) 1st lesion
2. 11103 (tangential biopsy of skin, each additional lesion) 2nd lesion
When two biopsies are performed using two different techniques, report the primary code and the add on code based on the type of biopsy performed.
Example #2: A physician performed a punch biopsy of the chest and an incisional biopsy of the left arm.
1. 11106 (incisional) 1st lesion
2. 11105 (punch biopsy each additional lesion) 2nd lesion
Example #3: A physician performed a shave biopsy on the left arm and leg and a punch biopsy on the chest.
1. 11104 (punch biopsy) 1st procedure,
2. 11103 (shave biopsy, each additional lesion, leg) 2nd procedure
3. 11103 (shave biopsy each additional lesion chest) 3rd procedure
Make sure you document the method of removal and anatomic site. Remember all excision codes include a biopsy so a separately biopsy code on the same structure is not appropriate. If an excision is performed even if the specimen is sent to pathology report an excision code. Report one code per lesion biopsied. When multiple biopsies are performed via different methods, report one primary code and use an-add on based on biopsy method for each additional biopsy on the same date.
CORRECTION: This article has been corrected to show that Example #3, 11103 should read: “(shave biopsy each additional lesion chest)” 3rd procedure