Podiatry Coding & Billing Alert

Question: When does a physician need to obtain a biopsy for skin lesions? What would be the rationale for the decision?

Answer: Sometimes, skin lesions are difficult to diagnose as physicians often see an unclear clinical picture. When faced with this dilemma, a physician usually decides to perform a biopsy. If you're billing a biopsy of skin and subcutaneous tissues, you should refer to 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for a single lesion and add CPT 11101 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; each separate/additional lesion [List separately in addition to code for primary procedure]) for each additional (separate) lesion. Closure of the biopsy is included in the procedure fee allowance.

Shave biopsy, wherein the physician essentially removes the entire lesion, uses the 11305-11308 (Shaving of epidermal or dermal lesions procedures) code series.

For a biopsy of the toenail/nail unit, you would report 11755 (Biopsy of nail unit [e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds] [separate procedure]). The code's description includes biopsy of the nail plate, nail bed, nail matrix and adjacent hyponychium, and nail folds.

Caution: Never use 11755 when simply clipping a loose or crumbling portion of nail for KOH or DTM testing of the nail.