# Deep or superficial?



## dellasanta (Mar 29, 2017)

When billing for biopsy of the mandible or maxilla, would the code for superficial bone biopsy be used since the mandible/maxilla is close to the body surface similar to the rib (such as code description for 20240 vs 20245 which is deep)?  I think my physician is using the wrong code.


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## CodingKing (Mar 29, 2017)

Superficial since the bone can be palpated. An example of deep would be a femur.


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## dellasanta (May 1, 2017)

My physician believes that 20225 can be used when the surgery requires elevation of muscle as in approaching the mandible through the skin or elevating muscle overlying the ramus or genial areas.  Does this make a difference when coding deep (20225) vs superficial (20220)?  I tend to think "no".


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## dellasanta (May 1, 2017)

Correction to my previous post, the code should be 20245 not 20225.  Typo, sorry


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## FTessaBartels (May 2, 2017)

*Depends on technique*

The key is HOW the biopsy is being performed
CPT 20245 - Biopsy, bone, *open;* deep (eg, humeral shaft, ischium, femoral shaft)   .... This is an OPEN technique, with the surgeon dissecting tissue away from the bone to obtain the biopsy


CPT 20220  Biopsy, bone,* trocar, or needle*; superficial (eg, ilium, sternum, spinous process, ribs)   ...  
CPT  20225 Biopsy, bone, *trocar, or needle*; deep (eg, vertebral body, femur) 
These are performed using a needle/trocar (i.e. percutaneously through the skin)

If he's using a trocar/needle ... I agree that the mandible is a "superficial bone"
But if he using an open technique I would code CPT 20245.

Hope that helps,

F Tessa Bartels, CPC, CEMC


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