Wiki Biopsy penis 11100 or 54100

[JesseL]

I'm not sure if I can bill 54100 for a biopsy of a lesion on the penis shaft if it was done by shave removal. I notice on the CPT code it's under "excision"

Do I bill 11100 instead? I told the provider it has to be an excisional biopsy to bill 54100 but I don't know if I'm right.

 

[morales1968]

Shave Biopsy

Shave biopsies have their own codes, have a look at 11305 - 11307

 

[JesseL]

Shave biopsies have their own codes, have a look at 11305 - 11307

Those codes are for shave removals without the intent of a biopsy though?

Code's like 11100 are for any method of removal. I'm not sure if 54100 applies the same way.

 

[JesseL]

Anyone else have a take on this?

 

[CatchTheWind]

The difference between the excision codes (114xx/16xx) and the shave codes (113xx) is that the former is full-thickness (ie: cutting all the way down to the sub-cutaneous layer) while the latter is partial-thickness (cutting only into the epidermis and dermis). The former requires closure, while the latter does not. Both groups of codes are used regardless of whether or not a biopsy will be sent out.

The difference between these codes and the biopsy codes is that the biopsy codes are used when only part of the lesion is removed.

As for the penis biopsy code, we have always used 54100. I am guessing that the term "excision" in the title of that section of CPT is being used in a different sense from the way we use it in dermatology ("full-thickness, complete removal") and just means "cutting out something or a part of something" Just a guess...

 

[JesseL]

The difference between the excision codes (114xx/16xx) and the shave codes (113xx) is that the former is full-thickness (ie: cutting all the way down to the sub-cutaneous layer) while the latter is partial-thickness (cutting only into the epidermis and dermis). The former requires closure, while the latter does not. Both groups of codes are used regardless of whether or not a biopsy will be sent out.

The difference between these codes and the biopsy codes is that the biopsy codes are used when only part of the lesion is removed.

As for the penis biopsy code, we have always used 54100. I am guessing that the term "excision" in the title of that section of CPT is being used in a different sense from the way we use it in dermatology ("full-thickness, complete removal") and just means "cutting out something or a part of something" Just a guess...

I guess I'll stick with the 54100 code.. wonder why the much higher RVU, guess just because it's on the penis. I deal with bad scribers that are too template reliant and I never really know if they took out part or whole lesion unless they state the size... curse templates.