Dermatology Coding Alert
Rely on Intent to Report Skin Lesion Removal Code
PDF
Question: If our dermatologist removes a skin lesion by shaving it and we send the removed tissue to the lab for analysis, should I report the procedure with the CPT® code for shaving, or should I use a biopsy code?
Michigan Subscriber
Answer: You should base your reporting on the intent of your clinician in performing the procedure. If your dermatologist’s primary intent in shaving the lesion was to send the tissue to the lab for analysis, you should report a biopsy code. Depending on the number of lesion(s) your internal medicine specialist biopsied, you can report 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for biopsy of one lesion and report the add-on code +11101 (…each separate/additional lesion [List separately in addition to code for primary procedure]) for every additional lesion removed.
But on the other hand, if your dermatologist shaved the lesion for the primary purpose of removing it and you sent it to the lab for analysis incidental to that procedure, you should report one of the shaving of epidermal or dermal lesion codes depending on the size of the lesion and the area of the body from which it was removed. For this purpose, you will have to report from one of the CPT® codes from the range 11300-11313.
CPT® guidelines preceding the biopsy codes are instructive in this regard. CPT® states:
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 obtaining of tissue for pathology during the course of these procedures is a routine component of such procedures. This obtaining of tissue is not considered a separate biopsy procedure and is not separately reported. The use of a biopsy procedure code (e.g., 11100, 11101) 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.
Dermatology Coding Alert
- Neoplasm Coding:
Neoplasms May Be Uncertain, But Your Coding Shouldn't Be
There’s a difference between “uncertain” and “unspecified”ICD-9 codes — and understanding it can mean success [...] - ICD-10:
701 Series Ends Up All Over the ICD-10 Map
New diagnosis codes for “other hypertrophic and atrophic conditions of skin” can be found in [...] - Reimbursement:
Final Fee Schedule Confirms Phasing Out of Global Periods
Dermatology practices, prepare for a 2 percent cut to Medicare payments. When CMS announced on [...] - Billing:
Step Up Your Benefits Verification for the New Year
Don’t leave eligibility checks to the last minute or you’ll face non-payment. With the new [...] - Reader question:
Rely on Intent to Report Skin Lesion Removal Code
Question: If our dermatologist removes a skin lesion by shaving it and we send the removed [...] - You Be the Coder:
Basal Cell Carcinoma Destruction
Question: Sometimes our surgeon excises in situ basal cell carcinoma, but sometimes he uses “destruction” methods [...]