Revenue Cycle Insider

Learn how to bill multiple biopsies with different techniques.

Skin biopsies are simple procedures that can be done in many healthcare settings and for several reasons. Betty A. Hovey, BSHAM, CCS-P, CDIP, CPC, COC, CPMA, CPCD, CPB, CPC-I, senior consultant and owner of Compliant Health Care Solutions, broke down the procedures during her “Minor Skin Procedures in the Office” session at AAPC’s HEALTHCON 2025.

Revenue Cycle Insider gathered some common myths regarding skin biopsies and set the record straight, so your surgery coding will be accurate.

Myth 1: Physicians perform biopsies only to check for cancer.

False — Physicians perform skin biopsies for several reasons, including evaluating a lesion for malignancy. Some of the reasons why physicians perform skin biopsies are:

• Unusual growths: These are spots on the skin that appear like they’re changing color, size, or shape.
• Rashes/infections: These could be rashes that act strangely or aren’t healing properly.
• Suspicious lesions: These spots may not look like the rest of the skin, or the spots may itch or bleed.

When it comes to billing the procedure, Hovey recommends looking at the physician’s intent for the visit. “You’re looking at what the intent of your physician or your advanced practice provider [APP] was so if they happen to take the whole lesion, but their intent was to biopsy, the procedure is a biopsy, and that’s how it should be billed,” Hovey stated.

Myth 2: There is a limit for the number of biopsy codes you can report.

False — For shave or tangential biopsies, punch biopsies, and incisional biopsies, the CPT^® code book does not place a maximum number on how many biopsy codes you can report. Regardless of whether the physician biopsies one or 30 lesions on a patient, you can and should report the number of codes to match the number of biopsies.

Example: For shave biopsies, you’ll report 11102 (Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion) for the first lesion and the appropriate number of units of +11103 (… each separate/additional lesion (List separately in addition to code for primary procedure)) to represent the rest of the lesions.

Say the doctor performs shave biopsies on 10 lesions in various locations on the patient’s body. You’ll report 11102 for the first lesion and 9 units of +11103 for the remaining lesions.

Myth 3: Report closures separately for incisional biopsies.

The truth behind this myth depends on the type of closure.

“If the surgeon does an incisional biopsy that’s big and it’s in a place where they need to close it, and they do a simple closure, then simple closures are bundled into an incisional biopsy. In that case, you would not be reporting the closure separately,” Hovey said.

On the other hand, if the physician does an incisional biopsy and needs to perform an intermediate or complex closure, then you can report the closure codes separately.

Myth 4: When the provider biopsies multiple lesions via different techniques, you’ll report a base code for each technique.

“You don’t code every base code. You report the base code with the highest relative value unit [RVU], and then use the add-on codes for everything else,” Hovey explained.

Scenario: A physician performs three biopsies on a patient. The provider performs an incisional biopsy with a simple closure and two shave biopsies.

The primary procedure codes (or base codes) for the biopsies in this scenario are 11106 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion) for the incisional biopsy and 11102 for the shave biopsy. The national RVUs for each code are as follows:

• 11106: 4.59
• 11102: 2.96

With this in mind, you’d assign 11106 as the primary procedure code and then 2 units of +11103 to report the multiple lesions biopsied using different techniques.

Myth 5: Report biopsy codes based on the number of biopsies collected.

This myth is false, and you can tell with a review of the CPT^® code descriptors. Each descriptor for the primary procedure codes include the wording “single lesion,” while the add-on codes feature “each separate/additional lesion.” This means that you will match the code count to the lesion count.

For example, if a physician performs two shave biopsies on one large lesion, that is still one shave biopsy procedure. “The codes are reported per lesion, not per biopsy,” Hovey stated.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC