Podiatry Coding & Billing Alert

Hint: Don’t miss these new rules for coding multiple skin biopsies.

In Podiatry Coding and Billing Alert Vol. 10, No. 12, you learned about the new CPT^® 2019 choices for skin biopsies you’ll have starting on January 1, 2019. But, there are more codes and subsequent guidelines to keep track of if you want to keep your skin biopsy claims in tip-top shape.

Keep on reading to dig into the new punch and incisional codes and guidelines.

Get to Know These New Punch Biopsy Codes

Your new punch biopsy codes for CPT^®  2019 are as follows:

• 11104 (Punch biopsy of skin (including simple closure, when performed); single lesion)
• +11105 (… each separate/additional lesion (List separately in addition to code for primary procedure)).

In a punch biopsy procedure, “the patient is anaesthetized and pierced typically using a disposable skin biopsy instrument,” according to Sherika Charles, CDIP, CCS, CPC, CPMA, compliance analyst with UT Southwestern Medical Center in Dallas, Texas. The instrument is usually a 2-8 mm pen that can go deep into the subcutaneous layer of layer and remove a full-thickness, cylindrical sample of skin.

Don’t miss: Not only do 11104 and +11105 include simple closure, as the code descriptors indicate, but also “manipulation of the biopsy defect to improve wound approximation is included in [the] simple closure,” according to according to CPT^® guidelines.

Example: The podiatrist uses a punch tool to perform a punch biopsy on a single lesion on the patient’s right foot. He also performs a simple closure. You would report 11104 for this service.

Equip Your Coding Arsenal With These Incisional Biopsy Choices

If you report incisional biopsies, you will have the following two new codes for CPT^® 2019:

• 11106 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion)
• +11107 (… each separate/additional lesion (List separately in addition to code for primary procedure)).

Incisional biopsies “involve removal of a larger and deeper amount of skin — a full-thickness sample of tissue penetrating deep to the dermis, into the subcutaneous space — which typically requires the use of a scalpel and involves a more complex closure,” Charles explains.

Don’t miss: When a physician performs an incisional biopsy, he must use a sharp blade, not a punch tool. Additionally, he will use a vertical incision or wedge to remove a full-thickness sample of tissue, according to the guidelines. As previously mentioned, the physician must go deep into the patient’s dermis, into the subcutaneous space.

Important: Incisional biopsies may sample subcutaneous fat, and the guidelines offer the example of biopsies that physicians perform to evaluate panniculitis. Additionally, although physicians might also perform closure along with incisional biopsies, you should not report simple closure separately, the guidelines reiterate.

Boost Your Multiple Biopsy Coding Skills

These new biopsy codes will be helpful because they will allow you to report more accurately based upon the documented technique the physician used, says Christine Marcelli, CPC, CPPM, CSFAC, practice manager at Stark County Foot & Ankle Clinic in Canton, Ohio. Also, there are new add-on codes to describe additional lesions. You can “mix and match” these new codes to report biopsies of numerous lesions by various methods, which makes things much clearer and easier.

According to the guidelines, if the physician uses multiple biopsy techniques during the same encounter, you should report only one primary lesion biopsy code such as new codes 11102 (Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion), 11104, or 11106.

When it comes to choosing the appropriate additional codes, you will want to adhere to the following rules, per the guidelines:

Rule 1: If the physician performs multiple biopsies of the same type, you should report the correct primary code for that biopsy in conjunction with the appropriate add-on code.

Rule 2: If the physician performs an incisional biopsy, you should report primary code 11106 along with add-on code +11103 for tangential; +11105 for punch; or +11107 for incisional to indicate the additional biopsies procedures.

Rule 3: If physician performs a punch biopsy, you should report primary code 11104 along with add-on code +11103 for tangential or + 11105 for punch to indicate the additional biopsies.

Rule 4: If the physician performs multiple tangential biopsies, you should report primary tangential biopsy code 11102 along with add-on code +11103 to identify the additional tangential biopsies.

Rule 5: When the physician uses the same biopsy technique on separate or additional lesions, you should report the correct add-on code, such as +11103, +11105, or +11107, to identify each additional biopsy.

Rule 6: If the physician mixes and matches two or three different biopsy techniques to sample separate or additional lesions, you should first report the appropriate primary biopsy code like 11102, 11104, or 11106. Then, you should choose the correct add-on code, such as +11103, +11105, or +11107, to identify each additional biopsy.

Putting it all together: The podiatrist performs three punch biopsies on three lesions on the patient’s left foot. You should report 11104X1, +11105X2, based on the rules set forth above.

On the other hand, say the podiatrist performs one incisional biopsy, one tangential biopsy, and one punch biopsy to sample three lesions on the patient’s left foot. For these services, you should report 11106X1, +11103X1, +11105X1, based upon the rules set forth above.