Pathology/Lab Coding Alert

Question:Our pathologist examined a “shave biopsy,” and when I spoke to the doctor’s office to clarify the specimen, I was told to code 11100. I thought the code was 88305 — could you please explain the difference and tell me which code is correct?

Iowa Subscriber

Answer: The answer is that the surgeon’s work to perform the shave biopsy should be described by the appropriate code from the integumentary section (10000 level CPT® codes), while the pathologist’s work to examine the shave biopsy specimen and provide a diagnosis comes from the lab and pathology section (80000 level CPT® codes).

You need to know what the surgical specimen is to code the pathology exam. That said, you don’t provide enough information to indicate that 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) is the correct code. A more likely code for a simple shave biopsy would be something from the range 11300-11313, (Saving of epidermal or dermal lesion, single lesion ….). The different codes in this range describe various body sites and lesion sizes.

Regarding the pathology code, you’ve listed the correct code (88305, Level IV - Surgical pathology, gross and microscopic examination, Skin, other than cyst/tag/debridement/plastic repair) if the specimen is a skin lesion. This is not a cyst, skin tag, debridement, or normal skin from a plastic repair, such as you’d receive from a 11300-11313 procedure. Skin specimens may include epidermis, dermis, and subcutaneous tissue, so 88305 would also be the correct pathology code if the surgeon performed the 11100 procedure.