Pathology/Lab Coding Alert

And use this clever coding trick when your provider performs multiple biopsies.

Knowing how to code for skin biopsies isn’t always as simple as it seems. That’s why several myths have sprung up about this very basic procedure.

So, we’ve separated the skin biopsy facts from the fiction, and busted two of the most common myths for you. To help, we’ve also provided a handy tip for selecting the correct primary skin biopsy code when your dermopathologist performs multiple skin biopsies using different techniques.

Myth 1: To Code a Skin Biopsy, Simply Choose the Appropriate Code From 11102-+11107

This first myth is partly true. Whenever a pathologist documents a skin biopsy, the first place you would logically turn to in CPT^® is the biopsy codes:

• 11102 (Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion)
• +11103 (… each separate/additional lesion …)
• 11104 (Punch biopsy of skin (including simple closure, when performed); single lesion)
• +11105 (… each separate/additional lesion …)
• 11106 (Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion)
• +11107 (… each separate/additional lesion …)

With these codes, you simply choose the one that most appropriately describes the technique your pathologist used to remove the tissue: either a tangential biopsy, which the pathologist accomplishes by shaving, slicing, or saucerizing the tissue sample from the surface of the skin; a punch biopsy, which involves removing a full-thickness cylindrical sample of skin using a 2-8 mm pen that goes deep into the subcutaneous skin layer; or an

incisional biopsy, which “involves removal of a larger, full-thickness sample of tissue from deep into the subcutaneous space and which typically involves the use of a scalpel and a more complex closure,” explains Sherika Charles, CDIP, CCS, CPC, CPMA, compliance analyst with UT Southwestern Medical Center in Dallas, Texas.

However, CPT^® also includes a long list of body-area specific biopsy codes that you will need to use for biopsies of the skin performed on certain areas of a patient’s body. They include, but are not limited to:

• Lip: 40490 (Biopsy of lip)
• Penis: 54100 (Biopsy of penis; (separate procedure))
• Vulva/perineum: 56605 (Biopsy of vulva or perineum (separate procedure); 1 lesion)) and +56606 (… each separate additional lesion …)
• Eyelid: 67810 (Incisional biopsy of eyelid skin including lid margin)
• Ear: 69100 (Biopsy external ear)
• Mouth: 40808 (Biopsy, vestibule of mouth) or 41108 (Biopsy of floor of mouth)

When beginning your search for the most specific code, always look in the CPT^® Index to verify whether a more specific code is available, before defaulting to the CPT^® codes from the 111xx category.

Remember: Any time there is a code more specifically describing the biopsy site, report the more site-specific biopsy code. This means you should not use 11102-+11107 if a biopsy code for the specific site exists elsewhere in CPT^®. And when you do report a site-specific code, “the specific location of each biopsy should be clearly supported by documentation,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, associate partner, Pinnacle Enterprise Risk Consulting Services LLC. “A pathologist may draw a picture of the location in handwritten notes. In an EMR, pictures of the lesion locations can be a challenge. So, a clear verbal description should be evident.”

Myth 2: When Reporting Multiple Biopsies, You Use a Primary Biopsy Code for Each Different Technique

This myth runs completely against CPT^® guidelines. If followed, it will result in denials and a possible loss of revenue, so the myth needs to be dispelled, and you need to learn the correct way to code these tricky scenarios.

Coding multiple biopsies of the same technique: CPT^® tells you to use the primary code “along with the corresponding add-on code(s).” Per CPT^®’s example, you would code three punch biopsies as 11104 x 1 and +11105 x 2.

Coding multiple biopsies of different techniques: In these encounters, CPT^® guidelines instruct you to “select the appropriate biopsy code (11102, 11104, 11106) plus an additional add-on code (+11103, +11105, +11107) for each additional biopsy performed.”

Know This Trick to Select the Primary Skin Biopsy Code

In the case of multiple biopsies, you’ll select the primary code for the first unit of the most extensive biopsy your pathologist performs. Fortunately, this is easy to figure out, as CPT^® lists the integumentary biopsy codes in hierarchical order from the least (11102) to the most (11106) extensive procedure.

Code this: Your pathologist performs two punch biopsies and three tangential biopsies on a patient. You would report 11104 x 1 for the first punch biopsy as it is the most extensive procedure, +11105 x 1 for the second punch biopsy, and +11103 x 3 for the three tangential biopsies.