Wiki lesion removal

[colleen2282]

I have a provider that will remove the whole lesion with intent to send the lesion for biopsy. my question is if the whole lesion is removed and is sent for a biopsy would that be coded as 11400 (removal of lesion) or should it be a 11102 biopsy even though the whole thing was removed.

 

[haraml7]

I have a provider that will remove the whole lesion with intent to send the lesion for biopsy. my question is if the whole lesion is removed and is sent for a biopsy would that be coded as 11400 (removal of lesion) or should it be a 11102 biopsy even though the whole thing was removed.

So this is where clinical and coding get all mixed together. So the way that i think of it is that your CPT manual is a guide, it helps you determine your code to bill to the insurance company. So if the provider "removed the lesion" and we have a code that, word for word, describes the procedure that is documented in the operational note then we would bill for that code. The provider is technically sending a "biopsy" no matter if a piece or whole lesion (in this particular case), he wants path to look at it so the provider is stating this as a "biopsy". If the provider in the note states that he did an biopsy (shave, scoop, saucerize, curette), this is different as well i would probably say your code could go towards 11102.
Now if the provider paid attention to margins, and that is stated in the note as well, this is another indicator that you can bill for the removal of a lesion, depending on path (malignant or benign). This could also be billed from the musculoskeletal section as well depending on if it is a lipoma vs. cutaneous nature (path results). Let me know if you have any questions. I don't really have all of the information to really say def its 11400 but this is just a run down of how i would see it.

 

[csperoni]

I agree that if the entire lesion is being removed, I would code from lesion excision codes and not biopsy codes. When the provider says they are sending "for biopsy" they likely really mean they are sending "for pathology".