Primary Care Coding Alert

Trio of new codes, add-ons will give procedure reporting new specificity beginning Jan. 1.

Big changes are coming to the integumentary system biopsy codes, changes that will test your knowledge of minor surgical techniques.

Do you know the differences between a tangential, punch, or incisional biopsy? If you do, then go to the head of the class — you’ll be able to handle each of the new procedure codes with ease when they come across your desk.

But if you don’t, or if you need a quick reminder, we’ve assembled all the information you’ll need in this handy guide to help you understand how to use the codes when they take effect on Jan. 1, 2019.

First, Remove These Biopsy Codes in the New Year

Before you implement any of the six new biopsy codes, make sure you delete the following two existing biopsy codes from your code book:

• 11100 — Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion
• +11101 — … each separate/additional lesion (List separately in addition to code for primary procedure).

The American Medical Association (AMA) probably deleted the codes due to the vagueness of their descriptors. While the deleted codes do describe how far under the patient’s skin a provider needs to go to obtain the tissue sample, and the CPT^® guidelines clearly state that these codes were solely for the purpose of biopsy and were not to be reported when “considered components of other procedures when performed,” the codes do not describe the various techniques a provider can use to obtain the tissue sample.

“The skin biopsy codes have always been a bit unclear in that regard, because they always seemed to me to imply a punch biopsy,” argues Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. “But a punch is also often used to completely excise a small suspicious lesion,” Bucknam adds, noting that this led to confusion over the procedure’s purpose.

Additionally, “the previous deleted codes were very broad and would require submitting medical records to justify the various techniques used for a certain type of biopsy,” says Sherika Charles, CDIP, CCS, CPC, CPMA, compliance analyst with UT Southwestern Medical Center in Dallas, Texas.

Then Get Technical With These New Codes

In all, CPT^® has introduced six new codes — three that describe removing single lesions with different, specific techniques and three add-on codes for removal of multiple lesions — for 2019:

• 11102 — Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion
• +11103 — … each separate/additional lesion (List separately in addition to code for primary procedure)
• 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)
• 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).

Each base code identifies a specific technique that might be challenging for coders who are less familiar with surgical techniques. But the following brief guide should help you distinguish between the codes, allowing you to report them quickly and accurately.

Tangential: As the descriptor for 11102/+11103 implies, you can use these codes when your provider takes a sample “along the tangent, or the sample is superficial,” according to Charles. The provider can accomplish this using the following techniques or instruments:

• Shave, which means removing a tissue sample by elevating the skin, then using a straight blade to slice the skin to the epidermis or superficial dermis level.
• Scoop, which requires going deeper than shaving and uses a straight or flexible blade.
• Saucerization, which is like a scoop but doesn’t go as deep and uses a razor that is folded. This technique is mostly used for lesions that may be melanomas.
• Curette, which can either refer to the instrument used in a scoop biopsy or to a curettage biopsy, which is a seldom-used technique to biopsy a difficult-to-reach anatomic area.

Punch: In this procedure, “the patient is anaesthetized and pierced typically using a disposable skin biopsy instrument” according to Charles. 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.

Incisional: This biopsy “involves 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,” explains Charles.

The Bottom Line

Coders seem to approve of the changes unanimously. “The new codes will allow more specific pricing and will make it clearer what was done,” says Bucknam. “I also expect that there will be new directions that will clarify that a skin biopsy is removal of all or part of a lesion without regard to the margins.”

“Having codes that address what the provider did specifically is the best way to report exactly what the provider did,” agrees Charles. “Having these new codes will help coders tell the complete story to payers about what type of procedure was performed.”

Further study: For a more comprehensive guide to biopsy techniques, go to www.aafp.org/afp/2011/1101/p995.html.