Clarification 111xx vs. 113xx

[SylviaW]

Hello there, I am new to the site and ready to explore help and advise and assitance for proper and correct billing and coding....

I have a sitatuation where our Derm MDs always code/bill for 111xx rather than 113xx in certain situations. Does anyone know why some MDs state "Shave Removal" "Shave Biopsy" and always bill same code 11100. Even though just a mole removed/shaved.

Would mole or wart be a shave lesion 113xx? Correct? Or biopsy? At times, it's just shaved mole and no pathology sent out, just simple mole removal; and a bandage given.

Any suggestions/advice?

Thank you, Sylvia

[DeeCPC]

The difference between these two code sets is whether the lesion was removed. If a complete removal then it is not a biopsy. When a lesion is removed by shave technique it is coded with 113xx.

'Does anyone know why some MDs state "Shave Removal" "Shave Biopsy" and always bill same code 11100.' If they have never had any coding instruction then they don't know that how they word these things changes the code set. Some providers think if the lesion is going to pathology then it is coded as a biopsy.

[SylviaW]

Thank you this helps.

I understand the difference between removal and shave, but some MDs do not understand the issue of documenting clearly what's being done.

Correct, if complete removal (of certain kind) then it's "not" biopsy. Agree.

Most of my Derm MDs use the wording "shave biopsy" and always code same CPT code 11100 - this is so confusing because by reading the note it does not sound like a biopsy, but a simple "lesion shave" like a mole/wart.

I think it be something I have to address again to my doctors about how they note their services, ha?

Shaving is horizontal slicing of a lesion like a wart or a mole and it can be epidermal/dermal therefore the 113xx is valid to use. Correct? That's my understanding from the CPT book over and over again.

Any input is greatly appriciated. Thank u