Dermatology Coding Alert

Published on Mon Jan 16, 2006 PDF

Question: I need some clarification of the site-specific biopsy codes. Is the helix of the ear considered part of the external ear for code 69100? And does code 40490 include just the lip mucosa, or any part of the lip? Some of the doctors here interpret it to include any part of the skin surface between the nose and the lip.


Massachusetts Subscriber


Answer: Code 69100 (Biopsy external ear) does include the ear's helix. When searching in the index of the CPT manual, you'll see that the correct sequence is "Biopsy, Ear," which leads you to 69100.

The helix is the long edge of the outer ear (where you sometimes see piercings above the earlobe) and is considered to be the outer ear.

However, code 40490 (Biopsy of lip) includes just the lip and the mucosa of the lip. For biopsies in the area between the lip and the nose (which includes the philtrum -- the midline groove that runs between the top of the lip to the nose) -- report 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (...each separate/additional lesion [list separately in addition to code for primary procedure]).

When it's possible to report a site-specific biopsy code, you should. Not only are they more accurate, but they usually pay more than 11100.

Compared to $75.61 for 11100 performed outside a facility (based on national average 2006 RVUs, unadjusted for geographic location), code 69100 would reimburse $92.25. Code 40490, if it were appropriate, would reimburse $104.91.