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General Surgery Coding Alert

Biopsy and Excision at the Same Time? Think Again

Published on Thu Jun 24, 2004

Reserve 11100/11101 for pathology specimens only

If you're reporting biopsy codes 11100 and 11101 separately from excisions or other biopsies, you're setting yourself up for denials and a possible audit. To avoid these problems, you should use 11100/11101 when the surgeon obtains a portion of a lesion for pathology only.

New Instructions Clarify Bundles

Instructional notes added to CPT 2004 clarify that you shouldn't report 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (... each separate/additional lesion [list separately in addition to code for primary procedure]) in addition to excision or other biopsy codes, says Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Professional Coding and Compliance Consulting in Manassas, Va.

Notes preceding the "Biopsy" portion of CPT instruct:

  • Report 11100 and 11101 only when the physician obtains a specimen, Castillo says. For example, the surgeon removes a portion of a patient's skin lesion (709.1, Vascular disorders of skin) and sends the specimen to pathology. In that case, you would use 11100. You should assign add-on code 11101 in addition to 11100 when the surgeon takes a biopsy of a second lesion. You may report one additional unit of 11101 for each additional biopsy the surgeon takes.

  • You can't report 11100 and 11101 when you bill for anotherprocedure, such as an excision. For instance, if the surgeon removes an entire lesion and submits it to pathology, you should use only 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less). You shouldn't use a biopsy code, because CPT considers the biopsy a component of 11400.

  • When the surgeon performs a biopsy on a different site from the excision, you may separately assign 11100 and 11101, Castillo says. For example, your surgeon removes an entire benign lesion from a patient's arm, and a portion of a lesion on a patient's neck. For the arm lesion, use 11400, and for the neck biopsy, report 11100-59 (Distinct procedural service). By appending modifier -59 to the second code, you indicate that the biopsy occurred at a separate location from the lesion removal.

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