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#1
06-23-2010, 07:02 AM
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Excisions and biopsies
If a doctor destroys or shaves a lesion using 17XXX codes or 113XX codes, can he charge a separate biopsy code, 11100, for the same lesion that he shaved or destroyed to indicate this was sent for a biopsy? Thanks, Nancy
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#3
06-23-2010, 09:34 AM
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Quote:
Title: Coding Communication: Shaving of Epidermal or Dermal Lesions Body: In the Biopsy section of the Integumentary System in the 2008 CPT codebook, the following statement within the guidelines caused confusion among coders and other users: “During certain surgical procedures in the integumentary system, such as excision, destruction, or shave removals, the removed tissue is often submitted for pathologic examination.” The reference to shave removals, which is merely an example, has been misconstrued to mean that biopsy codes are appropriate for these procedures. The intent of the Biopsy guidelines is to emphasize the separate nature of a biopsy procedure code. The October 2004 CPT Assistant provided the CPT guidelines for reporting skin biopsies (codes 11100-11101). This article focuses on the guidelines for reporting shaving of epidermal or dermal lesions (codes 11300-11313) and provides clarification on when it is appropriate to use them, and on the differences between a shave removal and a biopsy with a shave technique. Definition: Shaving of Epidermal and Dermal Lesions Shavingis the sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full thickness dermal excision. A shave removal is a distinct procedure. Removal of tissue does not necessarily constitute a biopsy and, therefore, should not be coded as such. A shave removal is not considered an excision, and excision codes should not be used to report these services. The removal of a lesion by the shave technique requires a superficial removal but does not require complete removal of a lesion. Whether a lesion is completely removed by the shave technique depends on its location and depth within the skin. Coding Tips • Shaving includes local anesthesia and chemical or electrocauterization of the wound, when performed. • The wound should not require suture closure. • CPT codes 11300-11313, which are defined by the shaving technique used to remove the lesion, may be reported for either benign or malignant lesions. • Select the appropriate code from the 11300-11313 series based on anatomic site and the largest diameter size of the lesion itself, not including any additional margin. The following examples illustrate several methods used to indicate the removal of a dermal and epidermal lesion by shave technique. Example 1 A man has a 0.5-cm flesh-colored, raised, benign-appearing dermal nevus on his chin that bothers him when he shaves. Such lesions arise deeper in the dermis but are not problematic unless they rise above the level of the adjacent skin. Appropriate treatment is to remove the raised component of such a lesion with the shave technique (ie, a shave removal), recognizing that the remainder of this benign lesion persists down in the dermis after the procedure and a complete removal is neither intended nor desirable. The fact that the removed tissue may be sent for pathologic examination and confirmation does not make this procedure a shave biopsy or biopsy procedure. That is not the intent of the procedure, and shaving this 0.5-cm facial lesion is reported with code 11310, Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less. Example 2 A dermatologist sees a patient with a pearly nodule on the nose suspicious for a basal cell cancer. The dermatologist recognizes that this appears to be a deeper lesion that is suspicious for a basal cell carcinoma, and that the lesion should be biopsied for pathological evaluation. A commonly used technique is to biopsy the raised component of that lesion using a shave technique to remove the elevated portion specifically for pathologic examination, with the intent that if it is a basal cell carcinoma, subsequent definitive treatment will then be undertaken. A shave technique may be selected in this instance because if the lesion on pathologic examination is shown to be a benign dermal nevus, for example, a deeper scar from the biopsy would have been avoided. In this example, it does not matter for coding purposes whether the physician selected a razor, a curette, a punch, or a scalpel as the instrument for the biopsy since each instrument would be coded in the same manner. The primary purpose of the procedure is to obtain tissue for pathologic examination. This second example is appropriately reported as a skin biopsy procedure, code 11100, Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion. The fact that a pathology report may state “specimen consists of a shaved specimen of skin” should not influence the decision of whether the procedure represents a skin biopsy by the shave technique or a shave removal of a lesion that happened to be submitted for pathologic confirmation. Nor does the result of the pathology determine the coding. As in Example 2, if the pathology did not show a basal cell carcinoma and showed only a benign lesion that was now removed, the intent has not changed, and it remains a biopsy. An instrument such as a razor blade is one of a number of instruments that may be used for either a shave removal or a skin biopsy, depending on the preference of the physician. Documentation Medical record documentation that includes an indication to justify a skin biopsy procedure–such as “suspicious lesion,” “changing mole,” “history of bleeding lesion,” “variable pigmentation,” or “atypical appearing nevus”–can be extremely helpful to the coder. It suggests a diagnostic intent. Similarly, documentation for a shave removal procedure might include “symptomatic lesion,” “rubs on waistband or bra,” “hits lesion shaving,” or any other reason why an elevated lesion is being removed with the shave technique. Such documentation suggests a therapeutic intent. However, it is the responsibility of the clinician performing the procedure to clearly indicate the purpose of the procedure and coders should obtain clarification as necessary. I hope this helps!
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Lucinda (Cindy) McGarry, CPC-P Applications Specialist Avera Health Plans Education Office Sioux Falls SD Local Chapter Past President Sioux Falls SD Local Chapter
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