Biopsy vs. excision

[thefosterfarm]

Question regarding Biopsy vs. Excision

Patient note:

" Patient notes "new" skin lesion on Right Lateral Shoulder. Approx. 1 cm oval shaped lesion, 1/2 hypopigmented, nodule noted inferiorly, and 1/2 varigated brown. Lesion Excised in ellipse, no margin. skin closed with 4-0 nylon
f/u prn path report"


The path report showed a stage III Malignant Melanoma with incomplete excision of the margin. Patient is being referred to another physician for complete excision of the Melanoma.

Now, the CPC coding exam review says that a biopsy code is for when not all of the lesion is removed, and an excision code = all lesion removed. I have also read on some dermatology websites that you should code what you did, in this case an Excision, and not a biopsy.

How does everyone feel about this??? All opinions are GREATLY appreciated!

[mitchellde]

This was an excision.. the physician removed the entire lesion as he noted, the path report shows there is invasion of the melanoma into the surrounding tissue which they referred then to another physician, but the entire initial lesion was removed. I hope this is helpful

[thefosterfarm]

Thank you! yes, all answers are helpful!

[jbblgagnon]

To code for an excision the op report must state that the physician did a full-thickness removal (thru the dermis). A biopsy is usually done by shave removal and does NOT go through the full-thickness of the skin.

[mitchellde]

May I disagree to a point? An excision is full thickness but that means thru the dermis to the subq tissue.. and a biopsy can be either full or partial thickness but is a removal of only a piece of a lesion, a punch which takes a small piece always goes full thickness. A shave removal though is only partial thickness which may be into the dermis but not through to the subq tissue. I just wanted to clarify, and thank you for bringing up the importance of knowing this piece of information.