Wiki biopsy codes 11300

[heatherbee]

My Physician does a lot of the 11300 codes and site specific codes such as 40490 for biopsies. We have not had a problem with payment in the past. Medicare is now denying these codes as not medically necessary. What codes for biopsies do other Physicians use? In my past practices they always used the 11100 code.

Thanks

 

[CatchTheWind]

11300 is to be used only when the lesion is shaved entirely off, and can be used whether you send any tissue out for biopsy or not. Shave biopsies (where the provider shaves off just a piece to send out) are coded as 11100+11101 (unless they are in an area that has a location-specific biopsy code).

 

[heatherbee]

That is what we are doing, but we are getting Medicare denials even after appeal stating we are doing shave removal.

 

[mattinglyn]

That is what we are doing, but we are getting Medicare denials even after appeal stating we are doing shave removal.

have you checked the diagnoises codes that are associated in LCD

 

[Eshay]

shave removal vs shave BX

My providers are little confused on shave removal vs shave Bx. They think shave removal is for Diagnostic and they use the D48.5 code on all of them. They don't think I need to hold for Pathology and should just bill them out using that code w/D48.5. Help

Thank you
Erica

 

[mitchellde]

You cannot use D48.5 because that dx code is not known until rendered by pathology. The diagnosis is not for use when the provider is not certain as to what the pathology will show, it is a patient diagnosis code and when the diagnosis is not known you code what is known which would be a skin lesion.