Primary Care Coding Alert

Question: A patient presented with what they thought was just an annoying wart, but the provider felt the lesion was suspicious and performed a biopsy. I’ve never encountered this before. How should I code this?

Kentucky Subscriber

Answer: How you code this depends on whether the provider used a tangential, punch, or incisional method:

Tangential biopsy: You should report codes 11102 (Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion) and +11103 (…each separate/ additional lesion (List separately in addition to code for primary procedure)) for tangential biopsy. Note: During a tangential biopsy, the physician will remove a sample of the patient’s epidermal tissue either with or without sections of the underlying dermis. Examples of tools used to perform a tangential biopsy include a flexible biopsy blade, an obliquely oriented scalpel, or a curette.

Punch biopsy: You should report codes 11104 (Punch biopsy of skin (including simple closure, when performed); single lesion) and +11105 (… each separate/ additional lesion (List separately in addition to code for primary procedure)) for a punch biopsy. Note: During a punch biopsy, the physician will use a punch tool and remove a full-thickness cylindrical sample of the patient’s skin. Punch biopsies allow for a relatively deep tissue sample, which can be more diagnostic than a superficial scrape or shave.

Incisional biopsy: You should report codes 11106 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion) and +11107 (…each separate/additional lesion (List separately in addition to code for primary procedure)) for an incisional biopsy. Note: If the physician performs an incisional biopsy, he will use “a sharp blade (not a punch tool) to remove a full-thickness sample of tissue via a vertical incision or wedge, penetrating deep to the dermis, into the subcutaneous space,” per CPT®.

If the documentation does not include enough information for you to report the specific method, query the provider for additional details.