Understanding Skin Biopsy Codes

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
March 23rd, 2021

A biopsy is a procedure done to obtain a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other procedures/services provided at that time."

If only a portion of a lesion is removed to determine its pathology, you should use a biopsy code 11102-11103. If the entire lesion is removed, you also have the option of reporting the shave removal codes 11300-11313 and excision codes for lesions 11400-11646, even if the lesion was sent to pathology.

TIP: Watch for sections with malignant codes and sections for benign lesion codes.

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia, 11420-11426.

Excision, malignant lesion including margins, trunk, arms, or legs, 11600-11606.

The difference between partial-thickness vs. full-thickness

Three Distinct Techniques


Other types of biopsies in specific anatomic sites will be found through the CPT manual as well, such as the following:

Nail Unit  11755 Intranasal  30100
Lip 40490 Vestibule of Mouth 40808
Tongue 41100 Floor of Mouth 41108
Penis 54100 Vulva or perineum 5660556606
Eyelid skin including lid margin 67810 Conjunctiva 68100
Ear 69100

Coding

Any combination of biopsies can be reported if applicable, as in this example:

11104 X 1, 11103 X 2, 11105 X 1

Only one primary lesion biopsy code is reported during the same encounter using 1110211104, or 11106. You can, however, report multiple techniques during the same encounter.

Lesions are billed as separate units of service if samples are taken from different lesions and separate sites.

If a large lesion is sampled at several separate locations or sites using a single biopsy code, then only one code should be reported.

References:

Understanding Skin Biopsy Codes. (2021, March 23). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/understanding-skin-biopsy-codes-36800.html

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