Podiatry Coding & Billing Alert

Question: I am so confused about the CPT^® guidelines for the new skin biopsy codes when reporting multiple biopsies. Can you please break down these rules for me?

Ohio Subscriber

Answer: According to the CPT^® 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 (Punch biopsy of skin (including simple closure, when performed); single lesion), or 11106 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion).

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 (Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to code for primary procedure); +11105 (Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure); or +11107 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure)) 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.