General Surgery Coding Alert

Look beyond integumentary codes.

You learned in “Bungle Skin Biopsy Coding and Lose Pay” on page 57 that 11000 (Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion) isn’t the only code in town to report skin biopsies.

In fact, if the surgeon takes the biopsy from a specific site listed elsewhere in CPT^®, you should not use 11100 to report the procedure.

Keep your surgery practice on track with the following list of codes that represent common biopsy sites your surgeon might encounter (values in brackets represent the 2018 MPFS national non-facility payment amount, conversion factor $35.9996):

• 11755 (Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)) [$135.00]
• 30100 (Biopsy, intranasal) [$141.48]
• 40490 (Biopsy of lip) [$132.48]
• 40808 (Biopsy, vestibule of mouth) [$192.60]
• 54100 (Biopsy of penis; (separate procedure)) [$205.56]
• 56605 (Biopsy of vulva or perineum (separate procedure); 1 lesion) [$83.88]
• +56606 (… each separate additional lesion (List separately in addition to code for primary procedure)) [$38.88]
• 67810 (Incisional biopsy of eyelid skin including lid margin) [$176.04]
• 69100 (Biopsy external ear) [$103.32].

Recall that 11100 pays $108 (2018 MPFS national non-facility payment amount, conversion factor $35.9996). Looking at the preceding list, you can see that all the site-specific codes pay more than 11100. In fact, penis biopsy pays $97.56 more than 11100.

Bottom line: Depending on the frequency that the surgeons in your practice perform these procedures, sacrificing approximately $20 to $100 per lesion could add up to significant sacrificed pay every year.