Wiki 11100 vs. 113 series codes

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I am having some confusion with skin biopsy codes (11100/11101) and shave excision codes (113 series codes).

Here is a scenario as to why:

I performed a billing audit on patient: Jane Doe

Doctor documents: Biopsy/removal via shave technique and/or shave biopsy. check pathology. wound care instructions given.

Diameter of suspicious lesion removed: 1cm verruca like papule

The doctor billed a 11100.

I know that a biopsy was performed, typically with skin biopsies you do not need a diameter, because only part of the lesion is removed. If documentation supports it: the doctor stated he removed the lesion (1cm) and not just a portion would it not be considered a shave excision? Is code selection based on "technique" (shave) or whether or not part of or all of the lesion was removed?

I know with some doctors they just document: biopsy performed or skin biopsy performed with no diameter documented. 11100 is applicable. For some reason the "shave biopsy" verbiage is confusing me. Does this make sense? I am pretty sure it is just the actual "verbiage" that is tripping me up.

Cindy Roberts
CPC, CPCD, CPRC
 
Year: 2004 CPT ASST

Issue: October

Pages: 4

Title: Skin Biopsy Coding Guidelines (October 2004)

Body: Coding Communication:Skin Biopsy Coding Guidelines



Documentation

Coding guidelines require that the assignment of codes be based upon physician documentation. When the procedure note or report title and narrative indicate biopsy(ies) was performed, the appropriate biopsy code(s) may be reported as long as they are consistent with the previously quoted biopsy guidelines and the content of the CPT code descriptor. Similarly, when the procedure documentation supports another integumentary system procedure such as shave removal, destruction, or excision of a lesion, the appropriate code for the documented procedure should be reported.

Common Sources of Confusion

Four common areas of confusion and the methods to resolve them are described in the following list.


A biopsy is the pathological examination of a specimen. This concept and variations of it create the impression that any procedure in which the specimen is sent to pathology is a biopsy. Based on the prior discussion about biopsies, that conclusion is erroneous. The biopsy guidelines and previous examples provide clarification needed to avoid inappropriate coding.


The term biopsy can be used as a generic description for surgical procedures on the skin. Because the term biopsy is better understood by patients than the term excision or shave removal, it has occasionally been used to describe those nonbiopsy procedures. Colloquially, patients understand that biopsies are used to determine whether a lesion is malignant. They also understand that biopsies are sent for pathological examination. It is easy to default to colloquial language that, while better understood by patients, fails to be explicit enough for coding purposes. This practice of using such language can eventually cross over into coding and cause inevitable confusion. If used frequently, the lines among these concepts blur and may lead to “mixed” documentation (see the next point of confusion). The solution: refer to the preceding guideline explanations and use proper medical terminology at all times in each context. Doing so provides an additional benefit to patients who learn the correct use of medical terms and derive additional specific information about the procedures performed.


It is acceptable if documentation mentions both biopsy and excision for a procedure on the same lesion. If necessary, the physician may need to clarify which procedure was performed. An addendum may be necessary. In these situations, only a single code may be reported for the procedure. If the procedure narrative describes excision, the appropriate code that supports the documented method used for excision should be selected. If the documentation supports a biopsy, the appropriate code(s) from 11100- 11101 should be reported.


The complexity of the biopsy procedure may vary significantly for different anatomical portions of the body. In consideration of this, the CPT coding system includes site-specific codes for a biopsy of select body areas. To conform to CPT guidelines that the most specific code should be used to identify a given service, code 11100 is to be used if no site-specific code is available.
 
I am sorry, but this still doesn't answer my question. I will be attending the Nashville Conference next week and I will have someone to clarify it further. Thank you for your response.

I did find this in Coding Edges September 2011 issue....... (what a coincidence) LOL.

Page 43 states:

"Many physicians use the term "shave biopsy". This can be confusing when coding because there is not a CPT with this exact verbiage. Your choices include 11100-11101 (biopsy) or the 11300-11313 shave excision codes. Careful review of the documentation and/or query of the physician is necessary for correct coding".

My question still lingers; If they remove only a portion via "shave", is it a skin biopsy (11100-11101) or shave excision (shave biopsy) 11300-11313?

Cindy Roberts, CPC, CPCD, CPRC
 
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Hi Cindy:

From this Coding Edge article posted on Pivot Health, my take is it depends on the intent of the procedure:

http://www.pivothealth.com/userfiles/pdf/090101%20Jennifer%20Swindle%20Clear-up%20Blemished%20Dermatology%20Coding%20Coding%20Edge.pdf:

A biopsy code also does NOT determine the method used to obtain the specimen. Often a
physician may report shave biopsy; however, this is still a biopsy. If the service’s intent is
to obtain a lesion specimen to send to pathology for identification, the method does not
change that the procedure done is a biopsy.

The biopsy intent is what makes this procedure different from an excision, destruction, or
shave removal. A biopsy captures a separate and independent service. A biopsy is
performed on a lesion or areas of the skin to diagnose skin diseases or conditions. The
purpose is to remove a skin portion or the suspicious area to be examined in pathology
for a definitive diagnosis. A biopsy is a biopsy—the method of how tissue was obtained
does not change the code.


Keep us posted on your findings from the conference.
 
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