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
- When sampling only a portion of the thickness of skin or mucous membrane (does not penetrate below the dermis or lamina propria)
- Sampling deep into the tissue, to the dermis or lamina propria, into the subcutaneous or submucosal space
Three Distinct Techniques
- Tangential Biopsy 11102, 11103
Performed with a sharp blade (e.g., shave, scoop, saucerize, curette) like a flexible biopsy blade, obliquely oriented scalpel, or a curette to remove a sample of epidermal tissue, this can be with or without portions of the underlying dermis. Removal of skin tags uses a different set of codes (11200, 11201), not to be confused with lesions. Therapeutic removal using a shave technique can also be done as a tangential biopsy using CPT codes 11300-11313; these are reported for reasons such as a symptomatic lesion that rubs on a waistband or bra. The provider must indicate the purpose of the procedure.
- Punch Biopsy 11104, 11105
A punch biopsy is used to obtain a cylindrical tissue sample. A simple closure is included in this procedure.
- Incisional Biopsy 11106, 11107
This procedure also requires a sharp blade and an incisional biopsy will allow the provider to obtain a full-thickness sample via a vertical incision or a wedge deep into the dermis into the subcutaneous space.
Other types of biopsies in specific anatomic sites will be found through the CPT manual as well, such as the following:
|Lip||40490||Vestibule of Mouth||40808|
|Tongue||41100||Floor of Mouth||41108|
|Penis||54100||Vulva or perineum||56605, 56606|
|Eyelid skin including lid margin||67810||Conjunctiva||68100|
Any combination of biopsies can be reported if applicable, as in this example:
- If a punch biopsy is performed, report 11104 in combination with two tangential (11103), and one punch (11105), for the additional punch biopsy procedures. Use the applicable add-on code if multiple biopsies of the same type are performed; for example, use the add-on code 11105.
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.