Primary Care Coding Alert

Question: A new patient reports to the FP for an initial E/M. During the course of a level-two service, the patient complains about an itchy red lesion on his left arm and a raised lesion on his left leg. The FP performs biopsies on both areas using a punch tool. What is the proper code for a punch biopsy?

Montana Subscriber

Answer: The biopsy code is 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion). This is the appropriate code when the FP performs skin biopsy with a punch tool. However, you-re selling the claim short if you report only 11100.

Why? Coding of biopsies is per lesion, meaning an add-on code is appropriate for the second lesion. Also, your FP provided a separate E/M service during the encounter, so you should code for that also.

On the claim, report the following:

- 11100 for the first biopsy

- +11101 (... each separate/additional lesion [list separately in addition to code for primary procedure]) for the second biopsy

- 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; straightforward medical decision-making) for the E/M

- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to 99202 to show the payer that the E/M and biopsies were separate services.