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Understanding Skin Biopsy Codes

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-03-23

A biopsy is a procedure done to obtain a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other procedures/services provided at that time."

If only a portion of a lesion is removed to determine its pathology, you should use a biopsy code 11102-11103. If the entire lesion is removed, you also have the option of reporting the shave removal codes 11300-11313 and excision codes for lesions 11400-11646, even if the lesion was sent to pathology.

TIP: Watch for sections with malignant codes and sections for benign lesion codes.

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia, 11420-11426.

Excision, malignant lesion including margins, trunk, arms, or legs, 11600-11606.

The difference between partial-thickness vs. full-thickness

  • Partial-thickness
    • When sampling only a portion of the thickness of skin or mucous membrane (does not penetrate below the dermis or lamina propria)
  • Full-thickness
    • Sampling deep into the tissue, to the dermis or lamina propria, into the subcutaneous or submucosal space

Three Distinct Techniques

  • Tangential Biopsy 11102, 11103
    Performed with a sharp blade (e.g., shave, scoop, saucerize, curette) like a flexible biopsy blade, obliquely oriented scalpel, or a curette to remove a sample of epidermal tissue, this can be with or without portions of the underlying dermis. Removal of skin tags uses a different set of codes (11200, 11201), not to be confused with lesions. Therapeutic removal using a shave technique can also be done as a tangential biopsy using CPT codes 11300-11313; these are reported for reasons such as a symptomatic lesion that rubs on a waistband or bra. The provider must indicate the purpose of the procedure.  

  • Punch Biopsy 11104, 11105
    A punch biopsy is used to obtain a cylindrical tissue sample. A simple closure is included in this procedure.
  • Incisional Biopsy 11106, 11107
    This procedure also requires a sharp blade and an incisional biopsy will allow the provider to obtain a full-thickness sample via a vertical incision or a wedge deep into the dermis into the subcutaneous space.


Other types of biopsies in specific anatomic sites will be found through the CPT manual as well, such as the following:

Nail Unit  11755 Intranasal  30100
Lip 40490 Vestibule of Mouth 40808
Tongue 41100 Floor of Mouth 41108
Penis 54100 Vulva or perineum 5660556606
Eyelid skin including lid margin 67810 Conjunctiva 68100
Ear 69100

Coding

Any combination of biopsies can be reported if applicable, as in this example:

  • If a punch biopsy is performed, report 11104 in combination with two tangential (11103), and one punch (11105), for the additional punch biopsy procedures. Use the applicable add-on code if multiple biopsies of the same type are performed; for example, use the add-on code 11105.

11104 X 1, 11103 X 2, 11105 X 1

Only one primary lesion biopsy code is reported during the same encounter using 1110211104, or 11106. You can, however, report multiple techniques during the same encounter.

Lesions are billed as separate units of service if samples are taken from different lesions and separate sites.

If a large lesion is sampled at several separate locations or sites using a single biopsy code, then only one code should be reported.

References