Wiki Shave Biopsies

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AprilSueMadison

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We have a pt who had a shave biopsy done. Note states

"Skin biopsy. A sample of the lesion was removed by shave biopsy to the level of the dermis and submitted to pathology".

There is NO size listed. (I'm working on correct documentation, but I'm still learning myself)

We are having a problem with this and I'm up to having to do an appeal. The claim was originally submitted as
17110
11100-59
17000-59
17003

After sending in the notes and information (because this was denied), I'm wondering if the shave biopsy is the problem. It looks like to me the correct coding should be
17110
11300-59
17000-59
17003
 
I would clarify what procedure was actually performed. Shave and a Biopsy are two different things. Correct verbage should be determined before submitting codes.
 
I'm unfortunately, slightly more confused. I have a printout now that used Ambulatory Coding and Payment Report from 2008 as a reference and it says that we are supposed to take physician intent into consideration. Now this is something I've never considered before.

It shows that if the provider shaved a small amount off specifically to be used for pathology, then code it as a biopsy. If it was just to remove the surface area of a lesion, then it would be a shave.

Also, using the study guide, it shows that shave removal is distinct from shave biopsy. Shave biopsy is 11100 and 11101. As long as they dictated biopsy, our documentation is correct.

So this leads me back to our claim denying. I'll have to look back through the modifiers. At least others in my position have two references to look at now.
 
I believe the issue is that you have used 3 different lesion removal codes and a biopsy in your original claim. You then changed the biopsy code to a shave excision code.

Based on what you have told us,

"Skin biopsy. A sample of the lesion was removed by shave biopsy to the level of the dermis and submitted to pathology".
Click to expand...

A shave biopsy (11100) is all that was done. There is no indication that the entire lesion was removed.

17110 - Destruction of benign lesions other than skin tags. . .up to 14 lesions.
11300 - Shaving of epidermal or dermal lesion
17000 - Destruction premalignant lesions; first lesion
+17003 - second through 14 lesions.
 
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