Podiatry Coding & Billing Alert

Question:  How should I code for the biopsy of nail bed and a 0.4- cm lesion on the left foot (great toe and second digit, respectively), for possible melanoma? Which ICD-9 code should I use?

Maine Subscriber

Answer:  Wait until the pathology report comes back before you do anything, because the codes you need depend on whether the lesion is malignant. If the biopsy comes back as malignant, report 172.7 (Malignant melanoma of the skin; lower limb, including hip) as the diagnosis. You should attach the toe modifiers, TA and T1, to their respective CPT codes.

For the biopsy of the nail bed for possible melanoma, use CPT 11755-TA (Biopsy of nail unit).

For the lesion on the left second toe, it depends on whether you took a biopsy or whether the entire lesion was excised. If the podiatrist excised the lesion, bill either 11620-T1 (Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) or 11420-T1 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less).

If the podiatrist only performed a biopsy, you would use 11100-T1 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion).