Wiki CPT Code for Map biopsies


Little Rock, AR
Best answers
Hi, all,

I am in an academic ophthalmology practice. On occasion, probably ½ a dozen times in the 10 years I have been here, the oculoplastics docs have the need to do a map biopsy. The purpose is to locate areas of positivity, and is typically due to the severity of the cancer (such as sebaceous cell carcinoma).

Not Moh’s, but similar, as they take blocks of tissue (usually both conjunctiva and eyelid skin) to define the extent of the cancer and determine management.

In the past we have had some luck with billing multiple 11100/11101s or 67810s as appropriate on separate line items (with modifiers and descriptions showing separate locations) and sending op notes, but more recently the 2 map biopsies the doctor did are getting denied for number of services.

This is very different from a single biopsy, and being paid for a single biopsy when 15 or so are performed seems unreasonable in these circumstances.

Do you think it would be reasonable to use an unlisted code for a map biopsy, since there is no existing code (such as a Mohs code) that describes what the docs are doing in this scenario? It is troubling because there are codes to describe the procedure (11100/67810), but because of frequency edits we aren't getting reimbursed for the multiple biopsies.

Thank you for your thoughts!