1. E

    Wiki Fat Pad Biopsy Question

    My practice is looking into performing fat pad biopsies in our office. Since this is a new procedure to us, I am not very familiar with biopsy procedures. The following is the technique he plans to use. The provider has suggested code 11104-Punch biopsy of skin. Is this correct based on the...
  2. R

    Question Colonoscopy Screening - Medicare

    How would you code a colonoscopy screening for Medicare? Patient has personal hx of polyps and is coming in for surveillance. A coworker is telling me she codes as below. Do you agree? 45380 - PT Z12.11 Z86.010 K63.5 K57.30 PREOPERATIVE DIAGNOSIS: 1.History of colon polyps...
  3. E

    Question Fat Pad Biopsy CPT Question

    Good morning, My practice is looking into performing fat pad biopsies in our office. Since this is a new procedure to us, I am not very familiar with biopsy procedures. The following is the technique he plans to use. The provider has suggested code 11104-Punch biopsy of skin. Is this correct...
  4. S

    Wiki Code 11102 + 11103 Denying Under Physician's Assistant

    Medicaid plan through Banner University Family Complete Care is denying codes 11102 + 11103 with a PA on the claim stating "99353 AHCCCS P353: PROVIDER TYPE NOT ELIGIBLE." The claim pays however when we resubmit under an MD as opposed to the PA originally on the claim. This issue began in Jan of...
  5. P

    Wiki MRI Prostate Fusion Biopsy

    What code are you reporting for MRI prostate fusion biopsy? I know that there is no specific code for this procedure. I have been reporting 55700. I was recently told to report 55899 instead. However, Medicare does not pay us on unspecified codes ending in 99. Just curious as to what others are...
  6. S

    Wiki Cold steel biopsy?

    Dermatology practice. Documentation states cold steel used to harvest the representative specimen for biopsy. Would this be considered 11102 or would you send back for more information/ clarification? thanks in advance.
  7. R

    Question Colonoscopy w/ Snare Biopsy - missing path

    When working a procedure where the documentation supports 45385 but the resulting lab sample is lost - is the procedure still coded snare biopsy? How does this effect dx?
  8. E

    Question Excision of Condylomata/skin tag

    The patient presents for complaint of lesions. The provider documents 1 skin tag on the glute, and 2 skin tag/ or Condylomata on the labia, 1-2 mm, and a vaginal polyp. If the provider moves forward with excision of all 3 lesions and the polyp removal, what CPT codes should be expected? I'm...
  9. L

    New biopsy codes with diagnosis of rash

    Has anyone seen an update on the Medicare LCD that came out for the new biopsy codes that didn't include the ICD-10 for rash? What are your providers billing to Medicare when this service is performed for this diagnosis?
  10. S

    Wiki New Biopsy with Destruction CCI Edits

    actinic keratosis - destruction lesions, Billed 17000, 17003 x 4 L57.0, one punch biospy DX D48.5 cpt 11102 59, medicare is denying paying the 11102 but denying the 17000 and 17003 , 236 This procedure or procedure/modifier combination is not compatible with another procedure or...
  11. A

    punch/incisional biopsy with closure

    My provider has documented that she did a punch biopsy with a layered (intermediate) closure. The CPT book states that simple closures are included in a punch biopsy but I have not been able to find any information on if intermediate or complex closures are separately billable with a punch or...
  12. J

    CPT 11102 & 11103 denying as in global/apart of another procedure

    Hello, I have a few claims from particularly Premera and Amerigroup - but they are denying CPT codes 11102 & 11103 when billed together, even with no office visit or other procedure. I called in to ask and I am told there is a CCI edit but I find no edits between these two codes. Is anyone else...
  13. L

    Denial 11755 modifer issue Cross Posted

    I also posted this in the modifier forum but here is the issue patient was seen for a full skin with hx etc 99213 it was paid the second item on there was 11755 a bx of the nail it was denied for incorrect modifier using a 59. IBC the payor recommended taking off modifier we did that they...
  14. L

    HELP 11755 denied for wrong modifer-Nail Bx Dermatology

    We have gotten a denial from IBC 2 times now for "wrong modifier" on 11755 billed charges were 99213 OV for Full Skin HX of MM etc 25 modifier(went thru and paid) 11755-bx of nail (billed with 59 modifier and denied then billed without modifier as suggested and denied.) So what modifier would...
  15. K

    Oral biospy cpt code

    Hi, I am new to Oral & Maxillofacial Surgery. I gave codes for the vestibule of the mouth and was told it is not the vestibule of mouth it's an oral biopsy Right retromolar area excision. So I found CPT 41826, Under Excision and Destruction Procedures on the Dentoalveolar Structures under...
  16. S

    Dilations and Biopsies during EGD

    My physicians will very seldom require to use an alternate method of dilation when one doesn't produce the result they desire. For example, they will perform a 43248(guide wire) and a 43249(balloon) in the same session. Most recently, we billed those two codes along with a 43239(biopsy) and...
  17. R

    Wiki Caridovascular Codes - Help

    Please help me! :confused: My cardiovascular coder is out if the office this week and of course a client needs urgent coding for authorizations. Can someone help me with the below descriptions? Again, these are for obtaining authorizations so there is no procedure report. Separate cases: 1...
  18. L

    Wiki Skin Tags 11200 and Biopsy code 11100

    Question Notes state pt came in for 15 skin tags dr states they are cosmetic and collected 115 to treat as cosmetic. Pt signed ABN form stating that they want the insurance billed for this service 11200 and while they realize we may ask for payment up front they want insurance to make final...
  19. C

    coding help zygomatic arch biopsy

    For the below op report my physician coded 20205 and 21034 -52. The CPT 21034-52 denied as an invalid modifier. How would you bill for the biopsies of the soft tissue of the zygomatic arch. Would you use 20200? Procedure: Op-Biopsy of the RT masseter muscle and the RT zygomatic arch...
  20. M

    Breast Biopsy or Lymph Node Biopsy???

    Hello AAPC members!! I have a question in regards to billing a procedure that I have come across! First of all, I am new to coding and I only have my CPB! Example: The patient has a biopsy of the breast (usually coded 19083), but the biopsy is of a lymph node of the breast! There is a separate...
  21. V

    11100 AND 11101 together ~ help, please

    Our dermatologist did 12 punch biopsies. Would I code it as 11100 for the first and 11101 with 11 units for the second, or would I list 11101 11 times? Would, then, 10 of the 11101 lines need a 59? Thanks for any help!
  22. B

    Biopsy CPT 11100 vs: 113xx

    hello, if anyone can help here, I'd greatly appreciate it. The verbiage on the note is as follows: R. post. thigh: Procedure: Shave biopsy. We discussed the differential diagnosis with the patient and the importance of shave biopsy in facilitating diagnosis. Furthermore, I stressed that the...
  23. A

    Right Heart Cath with Endomyocardial Biopsy

    Hi, Can someone please help me confirm if it is ok to add modifier 59 to 93451 in this particular situation? Our physicians do dozens of these procedures and I would like another opinion. I have included the pertinent portion of a sample procedure. RIGHT HEART CATHETERIZATION AND...
  24. C

    diagnosis coding for biopsy

    Patient comes in and has a biopsy I was taught in class to wait until the Path is recd back to bill with the correct dx. The physician I work for states we should bill with d48.5, Neoplasm, uncertain behavior. Which is correct and what do you do? If anyone knows where I can find it in black...
  25. B

    Colonoscopy with dilation plus biospy

    One of our Dr.'s preformed a colonoscopy with dilation at the termial ileum while doing this procedure he also obtained a biopsy. Should I just be coding the colon w/dil? or should I also code the biopsy? Hoping someone can offer some advice. Thank you.
  26. M

    20200 v. 20205

    Looking for opinions on the difference between 20200 (Biopsy, muscle; superficial) and 20205 (Biopsy, muscle; deep). Do the words "superficial" and "deep" which are integral parts of the code definition refer to the muscle (i.e. biopsy of a superficial muscle like the gastocnemius or a deep...
  27. A

    Radial Artery Biopsy

    The surgeon biopsied the radial artery by harvesting a 1cm length of the radial artery from the forearm and 2cm from the wrist. Is there a code for this?? Thanks in advance :confused:
  28. C

    Biopsy for small fiber neuropathy

    I bill for a Neurologist who wants to take biopsies for diagnosing the presence of small fiber neuropathy. The lab that performs the pathological component of this test has told him that we will bill with the biopsy codes 11100-11101. My concern is that the codes indicate a biopsy of lesion...
  29. A

    help with shave biopsy please

    I need help with documentation that states shave biopsy... Then in the 2nd statement states two lesions removed with diameters. Physician coding removal of lesions. Please refresh me on why provider would state shave biopsy, a shave biopsy is different than excision of lesion. Excision of...