ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining about an itchy red lesion on his left arm and a raised lesion on his left leg. According to the encounter notes, the physician performed a level-two E/M, and then biopsied both areas using a "punch tool." What is the proper code for a punch biopsy?

Montana Subscriber

Answer: The punch biopsy code is 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion). However, you-re selling the claim short if you just report 11100.

Why? Coding of biopsies is per lesion, meaning an add-on code is appropriate for the second lesion. Also, your physician provided a separate E/M service during the encounter. On the claim, report the following:

- 11100 for the first biopsy

- +11101 (... each separate/additional lesion [list separately in addition to code for primary procedure]) for the second biopsy

- 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision-making of low complexity) for the E/M

- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to 99282 to show that the E/M and biopsies were separate services.