Wiki Coding shave removal VS. biopsy VS. destruction

[JasperCPC]

I have a question about coding shave removal vs. biopsy vs. destruction. Physician documents shave removal then does an electrodessication to the same site. The specimen is sent for pathology. The intent is to remove the entire lesion but the diagnosis is not certain. If the path comes back as a benign lesion is this billed as: shave, biopsy, or destruction? Same question if the path comes back as malignant is it a biopsy or malignant destruction? If the physician documents biopsy and electrodessication how is this billed with a benign diagnosis; and how with a malignant diagnosis? Being a dermatology practice this is not new but recently has come up for debate so I want to clarify what is correct. Thank you!

 

[CatchTheWind]

I see this as a shave.

It would not be coded as biopsy, because the entire lesion was removed.

And you cannot use the pre-malignant or malignant destruction codes, because these explicitly exclude shaving as a method. (See the "exclusions" at the beginning of these categories in the CPT book.) The benign destruction codes don't explicitly exclude shaving, but the shave codes are more specific, and thus more appropriate.

The shave codes include cauterization. Since electrodessication is a form of cauterization, that should not change anything about the coding.