EXCISION OF LESION 68110 /68100 BIOPSY

[tharmon46]

I DON'T SEE THIS IN MY 360 CODING BOOK, BUT IS THE BIOPSY (68100) INCLUDED WITH THE EXCISION PROCEDURE (68110) DONE SAME DAY SAME SESSION SAME EYE, SAME LESION?

THANKS
THARMON

 

[cpc2007]

Yes the biopsy would typically be bundled when it is performed on the same lesion in the same eye during the same session/encounter as the more extensive excision procedure. A good source to check for bundling is the NCCI edits and the NCCI Policy Manual. Both are published by Medicare (CMS), but most mainstream non-Medicare payers also follow these rules. There is an NCCI edit on 68100 when reported with 68110. The NCCI Policy Manual in Chapter 8, section I.10 provide the rules for when a biopsy can and cannot be reported with a more extensive procedure like an excision:

- A biopsy performed at the time of another more extensive procedure (e.g., excision, destruction, removal) is separately reportable under specific circumstances.
- If the biopsy is performed on a separate lesion, it is separately reportable. This situation may be reported with anatomic modifiers or modifier 59 or XS.
- The biopsy is not separately reportable if used for the purpose of assessing margins of resection or verifying resectability.
- 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.

I hope that helps!

Kim
www.codingmastery.com