Wiki cpt 11100

[PMiklavcic]

if 2 separate punch biopsies are done on the same lesion, can you code for the additional punch biopsy? any help would be greatly appreciated.

thank you.

 

[lscale]

bundled or separate biopsy

Hi-
this was from the Nov 2010 coding edge. Hope this helps!


“If the biopsy is performed on the
same lesion on which a more extensive
procedure is performed, it is separately
reportable only if the biopsy is utilized
for immediate pathologic diagnosis
prior to the more extensive procedure,
and the decision to proceed with the
more extensive procedure is based on
the diagnosis established by the pathologic
examination.”
In other words, if the results of the biopsy
prompt the physician to perform a more
extensive procedure, both the more extensive
procedure and the biopsy may be reported.
As an example, consider a patient with
a suspicious lesion on the forearm: If the
physician excises the lesion and sends it
to pathology, we know that the biopsy is
not reported separately because, as NCCI
explains, “If a biopsy is performed and
submitted for pathologic evaluation that
will be completed after the more extensive
procedure is performed, the biopsy is not
separately reportable with the more extensive
procedure.”
Suppose, however, that the physician sends a
portion of the suspicious lesion for examination,
and pathology confirms a malignancy.
The physician proceeds to excise the entire
lesion. In this case, because the biopsy led to
the decision to perform the more extensive
procedure, both the excision (e.g., 11603
Excision, malignant lesion including margins,
trunk, arms, or legs; excised diameter 2.1 to
3.0 cm) and the biopsy (11100 Biopsy of skin,
subcutaneous tissue and/or mucous membrane
(including simple closure), unless otherwise listed;
single lesion) may be reported separately.
NCCI instructs you to append modifier 58
Staged or related procedure or service by the same
physician during the postoperative period to the
excision code (11603), “to indicate that the
biopsy and the more extensive procedure

 

[mitchellde]

if 2 separate punch biopsies are done on the same lesion, can you code for the additional punch biopsy? any help would be greatly appreciated.

thank you.

You may only report one biopsy of the same lesion. You could report both only if performed on separate lesions. The 59 modifier - separate site, separate organ, separate incision. If it is the same lesion you have not met the requirement to use the 59 modifier.

 

[PMiklavcic]

This helps tremendously............thank you both so much!!