General Surgery Coding Alert

Question: Our billing department reported two units of 27613 when our surgeon took two punch biopsy specimens from a single leg site, but the payer denied the second unit. Can we only bill one unit of 27613?

Utah Subscriber

Answer: You can bill multiple units of 27613 (Biopsy, soft tissue of leg or ankle area; superficial) -- under certain circumstances. You should limit coding to one unit for a single lesion, but you can report 27613 x 2 if the surgeon documents two separate lesions. Because your example involves one site, you should report only one biopsy code.

Problem: Your question is ambiguous because "punch biopsy" usually refers to an integumentary specimen that you should report with 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]). Note that these codes clearly define the lesion as the unit of service, so you should not report 11100 and +11101 for two punch biopsies from the same lesion.

On the other hand: If your surgeon took a soft-tissue biopsy, the correct code would be 27613. You should use this code only if the surgeon identifies the specimen as a soft tissue tumor, as opposed to skin.

Reader Questions and You Be the Coder were prepared with the assistance of Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program.