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akj

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Please see below. I initially was going to code these four biopsies as 11100 and 11101x3. I then considered the location and thought to bill 69100x4. Please help! :confused:

Patient presents for punch biopsy of lesion located on the following sites. He is aware that a scar can occur from this procedure.
Verbal and written consent received.


Lesion 1: left posterior auricle 2mm punch biopsy
Lesion 2: left posterior auricle 2 mm punch biopsy
Lesion 3: left posterior auricle 2 mm punch biopsy
Lesion 4 left posterior auricle 2 mm punch biopsy

Location of lesions was on top but slight posterior on auricle.

This area was prepped twice with betadine and vapocoolant spray.
2% lidocaine was used for anesthesia. A 2 mm punch biopsy, smooth pickups and No. 15 blade on a handle and smooth pickups were used.
The mole was biopsied. Mole will be sent into pathology. Hemostasis was with a small amount of electrocautery at the base and wound edges. The wound was cleansed again. It was then dried. 4 sutures of 4-0 ethilon simple suture were used for closure. The wound was prepped again. Antibiotic ointment and a bandage was applied.

Impression:. Punch biopsy of suspicious mole.

Four punch biopsies measuring 2 mm each were taken to get assessment of this lesion.
 
Would you code for 4 biopsies, or would you consider it one biopsy? I tried to code for the four, and got an edit back from our claims vendor 'Units Exceed Medicare MUE Value of 3 for 69100'.
 
AkJ,

Please disregard my previous post, do not use the 69100 codes. Since your physician is submitting the lesions to pathology I would use the the 11100 and the 11101 x 3. Since it is clearly stated they are being removed for biopsy and being sent to path.

(The physician removes a biopsy sample of skin, subcutaneous tissue, and/or mucous membrane for histologic study under a microscope. A single lesion is biopsied in 11100. Report 11101 for each separate lesion biopsied in addition to the primary procedure. Some normal tissue adjacent to the diseased tissue is also removed for comparison purposes. The excision site may be closed simply or may be allowed to granulate without closure)

Thanks,
 
Sutures have nothing to do with it. There are certain anatomical areas (ears, eyelids, lips, and genitals) that have their own biopsy codes, so when you do a biopsy in one of these areas, you use the "special" biopsy code, and not 11100. The "special" biopsy code for external ear is 69100. So there is no question that this is the correct code; the question is regarding how to code for multiples.

It actually IS medically unlikely that a patient would have four biopsies on the external ear, but "unlikely" does not mean impossible! Will your claims vendor let it through (with a warning)? If so, send it through, but expect to get a records request.
 
Maybe just wait for the path and mail the claim and path results to them. Save trouble and time in case they deny it.
 
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