Wiki 11102 & 17110 for same lesion?

[kimberlyogden@cox.net]

We have a provider that did a shave biopsy on part of a lesion then on the rest used liquid nitrogen. I am unable to find any resources regarding 2 different techniques for the same lesion. I am leaning towards both can't be billed, however, this provider needs explanation/proof as to why. Any help is greatly appreciated.

 

[KimberlySherman]

Only the lesion destruction 17110 may be coded. The NCCI Policy Manual states that a biopsy at the time of a more extensive procedure may not be coded for the same lesion (with one exception, which would not apply here). Here is the reference to share with your provider: The HCPCS/CPT codes for lesion removal include the procurement of tissue from the same lesion by biopsy at the same patient encounter. CPT codes 11102-11107 (biopsy of skin) shall not be reported separately. CPT codes 11102-11107 may be separately reportable with lesion removal HCPCS/CPT codes if the biopsy is performed on a different lesion than the removal procedure. [NCCI Policy Manual, Chapter III Surgery: Integumentary System, Section E. Lesion Removal, 2., page III-5]

The biopsy 11102 is also shown to bundle into 17110 by the NCCI Edits.

The NCCI Policy Manual is revised every year, and there are periodic updates throughout the year. You can download the latest revision here: https://www.cms.gov/Medicare/Coding/NCCI-Coding-Edits.

 

[Orthocoderpgu]

We have a provider that did a shave biopsy on part of a lesion then on the rest used liquid nitrogen. I am unable to find any resources regarding 2 different techniques for the same lesion. I am leaning towards both can't be billed, however, this provider needs explanation/proof as to why. Any help is greatly appreciated.

Have you checked the NCCI edits?

 

[kimberlyogden@cox.net]

Only the lesion destruction 17110 may be coded. The NCCI Policy Manual states that a biopsy at the time of a more extensive procedure may not be coded for the same lesion (with one exception, which would not apply here). Here is the reference to share with your provider: The HCPCS/CPT codes for lesion removal include the procurement of tissue from the same lesion by biopsy at the same patient encounter. CPT codes 11102-11107 (biopsy of skin) shall not be reported separately. CPT codes 11102-11107 may be separately reportable with lesion removal HCPCS/CPT codes if the biopsy is performed on a different lesion than the removal procedure. [NCCI Policy Manual, Chapter III Surgery: Integumentary System, Section E. Lesion Removal, 2., page III-5]

The biopsy 11102 is also shown to bundle into 17110 by the NCCI Edits.

The NCCI Policy Manual is revised every year, and there are periodic updates throughout the year. You can download the latest revision here: https://www.cms.gov/Medicare/Coding/NCCI-Coding-Edits.

Thank you so much!