Oncology & Hematology Coding Alert

Question: After completing a self-audit, we discovered quite a few instances where skin excisions were coded as biopsies, and vice-versa. Can you share the difference between these services?

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Answer: You are smart to delineate the difference between these services, because this is an area that commonly confuses practices from oncology to dermatology to general practice and beyond. When the physician intends to fully remove a lesion, he performs an excision. If the goal is just to take a sample of the lesion for pathology, a biopsy is performed.

Report a biopsy with CPT^® code 11100 (Biopsy ofskin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion). Report any separate additional biopsies with 11101 (…each separate/additional lesion [List separately in addition to code for primary procedure]). Additionally, the location of each biopsy should be clearly supported by documentation.

If the removal was an excision, the CPT^® code chosen will depend on the size of the lesion, where it is located, and whether the lesion is malignant or benign. You report excision of benign lesions with a code from the 11400-11446 (Excision, benign lesion…) range; you assign a code from the 11600-11646 (Excision, malignant lesion including margins…) range for malignant lesions.

Don’t miss: Shave removals are another common source of confusion. Report shave removals with CPT^® codes 11300-11313 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs…). Remember shave excisions are a technique for removal of a lesion and should not be confused with a biopsy, which is done only to determine the nature of the lesion. It is not intended to fully remove the lesion.