Primary Care Coding Alert

Learn how, when to document 11102-+11107.

When we reported on the introduction of the new CPT^® skin biopsy codes in Primary Care Coding Alert volume 20 number 11, we noted that the codes were a welcome addition to the 2019 code set.

However, we also noted that using them will be pretty complicated. So, we’ve prepared this guideline guide to help you implement the codes flawlessly.

Know the Techniques’ Purpose

In all, CPT^® introduced six new skin biopsy codes in 2019 — three that describe the different biopsy techniques and three add-on codes that you will use when your provider performs the specified procedure on multiple lesions.

• 11102 — Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion
• +11103 — … each separate/additional lesion …
• 11104 — Punch biopsy of skin (including simple closure, when performed); single lesion
• +11105 — … each separate/additional lesion …
• 11106 — Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion
• +11107 — … each separate/additional lesion ….

Coding alert: The codes are listed in hierarchical order from the least (11102) to the most (11106) extensive procedure. You will need to remember this when your provider performs multiple biopsies using different techniques, as we’ll see later.

These added codes not only allow you to distinguish between skin biopsy techniques, but the expanded guidelines that go with them help clear up confusion between coding for a biopsy or a lesion removal.

“CPT® has traditionally tried to define biopsy as taking a tissue sample without regard to whether a sufficient margin is taken and whether or not the entire lesion has been removed,” says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

“Historically, use of a skin biopsy code versus an excision code was a bit unclear, especially in regard to a punch biopsy, because a punch was also often used to completely excise a small suspicious lesion,” Bucknam adds. However, the new guidelines make it clear that the only purpose of all these procedures is “to obtain tissue solely for diagnostic histopathologic examination,” and that they must be “performed independently, or … unrelated or distinct from other procedures/services provided at that time.”

Coding caution: In other words, “Your provider’s intention must be clear when the procedure is performed,” advises Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin. “If the intent is to remove the lesion and then send it for pathology, then an excision code should be reported rather than a biopsy code, even though the lesion was sent to pathology,” Rasmussen adds.

Or, as CPT^® puts it: “It is the responsibility of physician or qualified health care professional performing the procedure to clearly indicate the purpose of the procedure.”

Know How to Report Multiple Biopsies

CPT^® guidelines also spell out how you should code multiple procedures of the same, or even different, techniques. For a single biopsy, naturally, you’ll report one unit of the appropriate primary code. You would then report multiple biopsies of the same technique with the primary code for the first biopsy and additional units of the related add-on. So, you would report three incisional biopsies as 11106 x 1, 11107 x 2.

Things gets tricky when multiple biopsies using multiple procedures are involved. The key is to remember the hierarchy of the biopsy types and these two rules:

1. Use the primary code for the first unit of the most extensive biopsy your provider performs.

2. Report additional procedures with the appropriate number of add-on code units associated with the less extensive procedure.

So, if your provider performs multiple skin biopsies of different types and one is an incisional biopsy, you should report 11106 and the corresponding number of units of the appropriate add-on codes.

Code this: Your provider performs two punch biopsies and three tangential biopsies on a patient. You would report 11104 x 1 for the first punch biopsy, +11105 x 1 for the second punch biopsy, and +11103 x 3 for the three tangential biopsies.

Know When Anatomic-Specific Biopsy Codes Take Precedence

“The other key to using the new codes is knowing that a body-area specific code would take precedence over codes 11102 through +11107,” says Rasmussen. “For example, if the skin area biopsied is the eyelid, you would use 67810 [Incisional biopsy of eyelid skin including lid margin].” “Documentation is key,” Rasmussen advises.

In addition to 67810, CPT^® provides a long list of biopsy codes you will need to use if your provider performs biopsies on other areas of a patient’s body. They include

• Lip: 40490 (Biopsy of lip)
• Penis: 54100 (Biopsy of penis; (separate procedure))
• Vulva/perineum: 56605 (Biopsy of vulva or perineum (separate procedure); 1 lesion and +56606 (… each separate additional lesion …)
• Ear: 69100 (Biopsy external ear).