General Surgery Coding Alert

Bill separately only if it's a different lesion or different site

For 2004, CPT has slightly revised skin biopsy code 11100 and updated the guidelines that precede the code, thereby clarifying when you may report such biopsies separately from other skin procedures.
 
The definition of 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) now eliminates the "separate procedure" designation. To clarify the meaning of this change, CPT includes a paragraph explaining that the tissue the surgeon obtains for pathology during excision, destruction or shave removals is bundled to the primary procedure, and therefore you may not report the biopsy separately. The guidelines note, however, that you may report a biopsy separately if the biopsy occurs independent of another skin procedure or if the biopsy takes place at a separate site/lesion. 
 
"The guidelines have made a distinction between sending tissue that was removed during a procedure for pathologic review and an actual biopsy, and specify that biopsies performed at the time of other skin procedures are separately reportable if they are on a different lesion or a different site," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM program coordinator at Clarkson College in Omaha, Neb. "In theory, this should not require a modifier, but most insurers will probably still bundle these codes, and you may still have to apply modifier -59 [Distinct procedural service] to get reimbursement."
 
For instance, if the surgeon removes a lesion from the left arm (for example, 11401, Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs, excised diameter 0.6 to 1.0 cm) and takes a biopsy from a different lesion on the same arm, the biopsy is separate from the excision and you may therefore report it separately (in other words, you would report 11401, 11100-59).